Individual
MR. JERRY TILLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8005 N POINT BLVD, SUITE H, WINSTON SALEM, NC 27106-3267
(336) 759-7207
(336) 759-7209
Mailing address
8005 N POINT BLVD, SUITE H, WINSTON SALEM, NC 27106-3267
(336) 759-7207
(336) 759-7209
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
HC3958
NC
Other
Enumeration date
12/08/2009
Last updated
12/08/2009
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