Individual
HENRY YOUNG TILLMAN III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
950 HWY 122 W, HAHIRA, GA 31632-1061
(229) 794-3003
(229) 794-3804
Mailing address
PO BOX 554, HAHIRA, GA 31632-0554
(229) 251-0099
(229) 247-5828
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN006926
GA
Other
Enumeration date
12/18/2011
Last updated
12/18/2011
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