Provider Demographics
NPI:1992710610
Name:TMC HARALSON FAMILY HEALTHCARE CENTER
Entity type:Organization
Organization Name:TMC HARALSON FAMILY HEALTHCARE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-838-8845
Mailing Address - Street 1:100 GREENWAY BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-4338
Mailing Address - Country:US
Mailing Address - Phone:770-838-8787
Mailing Address - Fax:770-812-5735
Practice Address - Street 1:204 ALLEN MEMORIAL DR
Practice Address - Street 2:SUITE 201
Practice Address - City:BREMEN
Practice Address - State:GA
Practice Address - Zip Code:30110-2047
Practice Address - Country:US
Practice Address - Phone:770-537-6500
Practice Address - Fax:770-824-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300033792AMedicaid
GADG2920OtherMEDICARE ID
GA367607289AOtherCLINIC RENDERING
GA367607289AOtherCLINIC RENDERING
GA300033792AMedicaid