Individual
MISS KENOSHA LATRICE TILLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
5220 ROSEWOOD PL, FAIRBURN, GA 30213-5113
(901) 277-7086
Mailing address
5220 ROSEWOOD PL, FAIRBURN, GA 30213-5113
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
GAA-NP000960
GA
Other
Enumeration date
10/16/2012
Last updated
11/07/2024
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