Individual
CONNIE KENDALL TILLMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
703 E. 9TH ST. BUILDING 4970, FORT STEWART, GA 31314
(912) 435-1384
Mailing address
180 TWIN PARKS DR, JESUP, GA 31545-7221
(912) 427-6064
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN091881
GA
163WC0400X
Case Management Registered Nurse
Primary
RN091881
GA
Other
Enumeration date
09/30/2014
Last updated
09/30/2014
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