Organization
BEHAVIORAL MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRISTOPHER J TILLITSKI PH.D. (PSYCHOLOGIST/PRESIDENT)
(478) 476-0403
Entity
Organization
Contact information
Practice address
3585 VINEVILLE AVE, MACON, GA 31204-1872
(478) 476-0403
(478) 476-9533
Mailing address
3585 VINEVILLE AVE, MACON, GA 31204-1872
(478) 476-0403
(478) 476-9533
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
001724
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
68BBDDL
MEDICARE ID
GA
Enumeration date
12/12/2007
Last updated
12/12/2007
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