Tillman, Courtenay L

Tillman, Courtenay L is an individual health care provider with primary practice located at 586 Brannen St , Statesboro GA 30458-5557. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Tillman, Courtenay L can be contacted via phone (912) 871-6611.

Contact Information

Primary practice address
586 Brannen St Statesboro GA 30458-5557
Phone: (912) 871-6611
Fax: (912) 871-6612
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X RN 159370NP Georgia

Profile Details

NPI number 1285746941
LBN Legal business name Tillman, Courtenay L
Credentials FNP-BC
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 31st, 2006
Last updated Sep 1st, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1285746941 NPPES
Georgia MEDICAID 901106018A
Georgia Other P00351681
Georgia Other 061407

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