Individual
COURTENAY L TILLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
586 BRANNEN ST, STATESBORO, GA 30458-5557
(912) 871-6611
(912) 871-6612
Mailing address
586 BRANNEN ST, STATESBORO, GA 30458-5557
(912) 871-6611
(912) 871-6612
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN 159370NP
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
061407
BC/BS OF GA GROUP #
GA
05
—
901106018A
—
GA
01
—
P00351681
RAILROAD MEDICARE
GA
Enumeration date
08/31/2006
Last updated
09/01/2015
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