NPIMap

Individual provider Active NPI

Paul Russell Tillman

  • Pharmacist
  • Gainesville, GA
National Provider Identifier
1447536859
Registry record updated Oct 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
RPH022817 Issued in GA
Practice address
3414 Mundy Mill Rd
Gainesville, GA 30507-8215
Phone
(770) 287-8359
Fax
(770) 287-8606
NPI assigned
Oct 30, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 30, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X RPH022817 GA Primary

Addresses

Primary practice location

3414 Mundy Mill Rd
Gainesville, GA 30507-8215

Mailing address

3414 Mundy Mill Rd
Gainesville, GA 30507-8215
Phone (770) 287-8359

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

State licenses

LicenseStateTypeSpecialty
RPH022817GAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Walgreen Co PastSince Oct 13, 2024 Accepting new patients
Walgreen Co Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1319932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319932800000",
    "number": "1447536859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3414 MUNDY MILL RD",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305078215",
            "telephone_number": "770-287-8359",
            "fax_number": "770-287-8606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3414 MUNDY MILL RD",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305078215",
            "telephone_number": "770-287-8359",
            "fax_number": "770-287-8606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLMAN",
        "first_name": "PAUL",
        "middle_name": "RUSSELL",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-10-30",
        "last_updated": "2011-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "GA",
            "license": "RPH022817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.