Tillman Medical Group PA

Primary specialty

SpecialistTaxonomy code 174400000X

License

5D595 Issued in LA

Legal business name

TILLMAN MEDICAL GROUP PA

Practice address

107 Front St
Vidalia, LA 71373-2836

Phone

(318) 336-2216

NPI assigned

May 12, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tana L Archer

Title

Accounts Manager

Phone

(318) 336-2216

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Tillman Medical Group PA

  • Specialist
  • Jonesville, LA
  • NPI 1922124312

  Member Of

  NPD member

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Susan A Davis, FNP

  • Family Nurse Practitioner
  • Jonesville, LA
  • NPI 1396794723
  Medicare reassignment NPD
• Charla Wurster Knapp, NP

  • Family Nurse Practitioner
  • Natchez, MS
  • NPI 1083851026

  LA

  Medicare reassignment NPD
• Barry Forrest Tillman, M.D.

  • Pulmonary Disease Physician
  • Vidalia, LA
  • NPI 1457349110
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370304000000",
    "number": "1043260615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 FRONT ST",
            "city": "VIDALIA",
            "state": "LA",
            "postal_code": "713732836",
            "telephone_number": "318-336-2216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 FRONT ST",
            "city": "VIDALIA",
            "state": "LA",
            "postal_code": "713732836",
            "telephone_number": "318-336-2216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TILLMAN MEDICAL GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2013-06-04",
        "status": "A",
        "authorized_official_last_name": "ARCHER",
        "authorized_official_first_name": "TANA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ACCOUNTS MANAGER",
        "authorized_official_telephone_number": "318-336-2216"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "LA",
            "license": "5D595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Head and Neck Clinic LLC
• Cora Thomas
• Troy Nolan Thomas Jr., RSW
• Alexis Brianna Thompson, RN, BSN
• Lynncoy Thornburg
• Barry Forrest Tillman, M.D.
• Clifford Randolph Tillman
• Total Urgent Care
• Town of Vidalia
• Dominique Trimble

• Specialist in Vidalia, LA
• Providers in Vidalia, LA by specialty
• Specialist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.