Provider Demographics
NPI:1932210226
Name:TILLMAN, EDWARD (MRE)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:TILLMAN
Suffix:
Gender:M
Credentials:MRE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 LAKE VIEW LN NW
Mailing Address - Street 2:
Mailing Address - City:ARAB
Mailing Address - State:AL
Mailing Address - Zip Code:35016-4552
Mailing Address - Country:US
Mailing Address - Phone:256-931-4809
Mailing Address - Fax:
Practice Address - Street 1:22165 US HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-8994
Practice Address - Country:US
Practice Address - Phone:256-582-4465
Practice Address - Fax:256-582-5339
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)