Individual
KELLY TILLMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
23702 HWY 80 E, STATESBORO, GA 30461-0845
(912) 489-4090
Mailing address
4700 WATERS AVE, SAVANNAH, GA 31404-6220
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN161574
GA
Other
Enumeration date
10/06/2015
Last updated
10/27/2020
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