Individual
MRS. PATRICE VIVIEN TILLMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN,MSN
Contact information
Practice address
175 GWINNETT DR, LAWRENCEVILLE, GA 30045-8444
(770) 339-5000
(770) 822-1698
Mailing address
175 GWINNETT DR, LAWRENCEVILLE, GA 30045-8444
(770) 339-5000
(770) 822-1698
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
RN058224
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN058224
RN LIC.
GA
Enumeration date
01/03/2007
Last updated
07/08/2007
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