Individual
DR. JOHNIE STUART TILLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
300 W HOSPITAL RD, ATTN: CREDENTIALS, FORT GORDON, GA 30905-5741
(706) 592-6722
(706) 787-8176
Mailing address
300 W HOSPITAL RD, ATTN: CREDENTIALS, FORT GORDON, GA 30905-5741
(706) 592-6722
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
029995
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
VAD 000
MILITARY TREATMENT FACILITY
GA
Enumeration date
07/10/2008
Last updated
07/10/2008
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