Provider Demographics
NPI:1952369365
Name:TILLMAN, WILLIAM F (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:F
Last Name:TILLMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12010 OLD MOUNTAIN PARK RD NE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-1716
Mailing Address - Country:US
Mailing Address - Phone:770-587-4948
Mailing Address - Fax:770-587-4948
Practice Address - Street 1:12010 OLD MOUNTAIN PARK RD NE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-1716
Practice Address - Country:US
Practice Address - Phone:770-587-4948
Practice Address - Fax:770-587-4948
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0181912085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAMEDICAL LICENSEOther018191