Organization
TILLMAN MEDICAL GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANA L ARCHER (ACCOUNTS MANAGER)
(318) 336-2216
Entity
Organization
Contact information
Practice address
107 FRONT ST, VIDALIA, LA 71373-2836
(318) 336-2216
Mailing address
107 FRONT ST, VIDALIA, LA 71373-2836
(318) 336-2216
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5D595
LA
Other
Enumeration date
05/12/2006
Last updated
06/04/2013
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