Active NPI
Johnie Stuart Tillman, M.D.
- Family Medicine Physician
- Fort Gordon, GA
National Provider Identifier
1124282090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 029995
- Practice address
- 300 W Hospital Rd
Attn: Credentials
Fort Gordon, GA 30905-5741 - Phone
- (706) 592-6722
- Fax
- (706) 787-8176
- NPI assigned
- Jul 10, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 029995 | GA | Primary |
Addresses
Primary practice location
300 W Hospital Rd
Attn: Credentials
Fort Gordon, GA 30905-5741
Mailing address
300 W Hospital Rd
Attn: Credentials
Fort Gordon, GA 30905-5741
Phone (706) 592-6722
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| VAD 000 | Other | GA | MILITARY TREATMENT FACILITY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 029995 | GA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1215648000000",
"number": "1124282090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 W HOSPITAL RD",
"address_2": "ATTN: CREDENTIALS",
"city": "FORT GORDON",
"state": "GA",
"postal_code": "309055741",
"telephone_number": "706-592-6722"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 W HOSPITAL RD",
"address_2": "ATTN: CREDENTIALS",
"city": "FORT GORDON",
"state": "GA",
"postal_code": "309055741",
"telephone_number": "706-592-6722",
"fax_number": "706-787-8176"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TILLMAN",
"first_name": "JOHNIE",
"middle_name": "STUART",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-07-10",
"last_updated": "2008-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "GA",
"license": "029995",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MILITARY TREATMENT FACILITY",
"identifier": "VAD 000",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Gordon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.