Provider Demographics
NPI:1881665255
Name:TILLMAN, DONALD A (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:A
Last Name:TILLMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4637 CLAY TILLMAN RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:31038-3854
Mailing Address - Country:US
Mailing Address - Phone:706-476-4616
Mailing Address - Fax:
Practice Address - Street 1:4637 CLAY TILLMAN RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:GA
Practice Address - Zip Code:31038-3854
Practice Address - Country:US
Practice Address - Phone:706-476-4616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0013841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAR13036Medicare UPIN
GA80BBFLFMedicare ID - Type Unspecified