Individual
DR. OTIS EDWARD TILLMAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1942 NORTH AVENUE, COLUMBUS, GA 31901
(706) 596-1245
(706) 576-4245
Mailing address
1942 NORTH AVENUE, COLUMBUS, GA 31901
(706) 596-1245
(706) 576-4245
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
040576
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00669127C
—
GA
01
—
224251
BCBS OF GEORGIA
GA
01
—
60027547
BCBS OF ALABAMA
AL
Enumeration date
10/03/2006
Last updated
07/08/2007
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