Provider Demographics
NPI:1649332776
Name:TILLMAN, JAMES E (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:TILLMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:723 E FORSYTH ST
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3718
Mailing Address - Country:US
Mailing Address - Phone:229-924-5123
Mailing Address - Fax:229-931-0375
Practice Address - Street 1:723 E FORSYTH ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3718
Practice Address - Country:US
Practice Address - Phone:229-924-5123
Practice Address - Fax:229-931-0375
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA692T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist