NPIMap

Organization Active NPI

TLC of Georgia LLC

  • Family Nurse Practitioner
  • Bonaire, GA
National Provider Identifier
1124407440
Registry record updated Oct 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
TLC OF GEORGIA LLC
Practice address
774 Ga Highway 96
Bonaire, GA 31005-3300
Phone
(478) 988-5711
NPI assigned
May 19, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Thomas Shelly Jr.
Title
VP & General Manager
Phone
(615) 425-4200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

774 Ga Highway 96
Bonaire, GA 31005-3300

Mailing address

2620 Elm Hill Pike
Nashville, TN 37214-3108
Phone (615) 425-4200

National Provider Directory

National Provider Directory
Tax ID family
TLC of Georgia LLC19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1431993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761091200000",
    "number": "1124407440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2620 ELM HILL PIKE",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372143108",
            "telephone_number": "615-425-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "774 GA HIGHWAY 96",
            "city": "BONAIRE",
            "state": "GA",
            "postal_code": "310053300",
            "telephone_number": "478-988-5711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TLC OF GEORGIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-19",
        "last_updated": "2025-10-22",
        "certification_date": "2025-10-22",
        "status": "A",
        "authorized_official_last_name": "SHELLY",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "VP & GENERAL MANAGER",
        "authorized_official_telephone_number": "615-425-4200",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bonaire, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.