Individual
MS. CANDACE MARVENIA TILLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RNC, MS, WHNP-BC
Contact information
Practice address
3230 OLD CHURCH CV NE, CONYERS, GA 30012-2647
(678) 221-8855
Mailing address
3230 OLD CHURCH CV NE, CONYERS, GA 30012-2647
(678) 221-8855
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
RN142932
GA
363LW0102X
Women's Health Nurse Practitioner
RN142932
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN142932
STATE OF GEORGIA
GA
Enumeration date
02/02/2012
Last updated
09/08/2024
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