Individual
DR. DERYUS TILLMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DNP, NP-C
Contact information
Practice address
2564 ENTERPRISE DR, OPELIKA, AL 36801-6860
(205) 848-2273
Mailing address
48 WILLOW TRACE DR, PHENIX CITY, AL 36869-7105
(706) 799-3906
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1-197726
AL
363LF0000X
Family Nurse Practitioner
GAA-NP003150
GA
Other
Enumeration date
02/10/2022
Last updated
02/05/2025
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