Organization
TILLMAN MEDICAL GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN DAVIS APRN (ADMINISTRATOR)
(318) 339-4112
Entity
Organization
Contact information
Practice address
800 AUDUBON DR, JONESVILLE, LA 71343
(318) 339-4112
(318) 339-6388
Mailing address
800 AUDUBON DR, JONESVILLE, LA 71343
(318) 339-4112
(318) 339-6388
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
07480R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447498
—
LA
Enumeration date
03/21/2007
Last updated
07/08/2008
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