Individual
IAN TILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1148 14TH AVE S, BIRMINGHAM, AL 35205-5215
(850) 346-6490
Mailing address
1148 14TH AVE S, BIRMINGHAM, AL 35205-5215
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
06/28/2023
Last updated
06/28/2023
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