Organization Active NPI

TLC Podiatry, P.C.

  • Primary Podiatric Medicine Podiatrist
  • Waycross, GA
National Provider Identifier
1770670416
Registry record updated Dec 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Podiatric Medicine PodiatristTaxonomy code 213EP1101X
License
000743 Issued in GA
Legal business name
TLC PODIATRY, P.C.
Practice address
605 Mary St
Waycross, GA 31501-3726
Phone
(912) 285-0069
NPI assigned
Oct 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2010

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

Authorized official

Name
Dr. Emily Arlene Via-Bowers, D.P.M.
Title
President
Phone
(912) 285-0069

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Podiatric Medicine PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213EP1101X 000743 GA Primary

Addresses

Primary practice location

605 Mary St
Waycross, GA 31501-3726

Mailing address

605 Mary St
Waycross, GA 31501-3726
Phone (912) 285-0069

Other identifiers 1

IdentifierTypeStateIssuer
00623334BMedicaidGA

National Provider Directory

National Provider Directory

Locations

605 Mary St
Waycross, GA 31501
Phone (912) 285-0069

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291334400000",
    "number": "1770670416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 MARY ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315013726",
            "telephone_number": "912-285-0069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 MARY ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315013726",
            "telephone_number": "912-285-0069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TLC PODIATRY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2010-12-03",
        "status": "A",
        "authorized_official_last_name": "VIA-BOWERS",
        "authorized_official_first_name": "EMILY",
        "authorized_official_middle_name": "ARLENE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "912-285-0069",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "213EP1101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "GA",
            "license": "000743",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00623334B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waycross, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2010; 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.