Individual
KATHERINE TILLEM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8901 STONEBRIDGE BLVD STE 200, DOUGLASVILLE, GA 30134-2254
(943) 202-7120
(470) 986-7087
Mailing address
8901 STONEBRIDGE BLVD STE 200, DOUGLASVILLE, GA 30134-2254
(943) 202-7120
(470) 986-7087
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9345
GA
363A00000X
Physician Assistant
—
—
Other
Enumeration date
08/06/2019
Last updated
05/17/2024
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