Tifton Addiction Associates, LLC. D/B/a TLC Clinic

Primary specialty

Addiction Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084A0401X

License

NTP001047 Issued in GA

Legal business name

TIFTON ADDICTION ASSOCIATES, LLC. D/B/A TLC CLINIC

Practice address

2402 North Tift Ave Suite 202
Tifton, GA 31794

Phone

(229) 382-7898

NPI assigned

Jan 14, 2011

Last updated

Jan 14, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jonathan Paul Connell

Title

Managing Member

Phone

(229) 382-7898

Specialties & licenses 4

Addresses

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

{
    "created_epoch": "1294963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294963200000",
    "number": "1821393380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2402 TIFT AVE N STE 202",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317941885",
            "telephone_number": "229-382-7898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2402 NORTH TIFT AVE SUITE 202",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "31794",
            "telephone_number": "229-382-7898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIFTON ADDICTION ASSOCIATES, LLC. D/B/A TLC CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-14",
        "last_updated": "2011-01-14",
        "status": "A",
        "authorized_official_last_name": "CONNELL",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "229-382-7898"
    },
    "taxonomies": [
        {
            "code": "1835P1200X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacotherapy",
            "state": "GA",
            "license": "PHOP000045",
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "GA",
            "license": "NTP001047",
            "primary": false
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "GA",
            "license": "NTP001047",
            "primary": true
        },
        {
            "code": "2084P0802X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "GA",
            "license": "NTP001047",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Addiction Medicine (Psychiatry & Neurology) Physician in Tifton, GA
• Providers in Tifton, GA by specialty
• Addiction Medicine (Psychiatry & Neurology) Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2011; 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.