Christopher Tillitski, PH.D.

Primary specialty

Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X

License

001724 Issued in GA

Practice address

3585 Vineville Ave
Macon, GA 31204-1872

Phone

(478) 476-0403

Fax

(478) 476-9533

NPI assigned

Oct 2, 2006

Last updated

Aug 15, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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

• Behavioral Medicine, LLC

  • Psychologist
  • Macon, GA
  • NPI 1457534513
  NPD (past) Authorized official

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344988800000",
    "number": "1467545988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3585 VINEVILLE AVE.",
            "city": "MACON",
            "state": "GA",
            "postal_code": "31204",
            "telephone_number": "478-476-0403",
            "fax_number": "478-476-9533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3585 VINEVILLE AVE",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312041872",
            "telephone_number": "478-476-0403",
            "fax_number": "478-476-9533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLITSKI",
        "first_name": "CHRISTOPHER",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2012-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "GA",
            "license": "001724",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "582147620",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000521683B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alyson Tidwell
• Cameron Austin Tidwell, NP-C
• Leslie G Tidwell, MD
• William L Tift, M.D.
• Patricia Kelly Tillery, PHARMD
• Judith J. Tillman, RN, MSN, NP-C
• Lisa Ann Tillman, NP-C
• Courtney Anne Timmerman, BS
• George Allen Tindol Jr., M.D.
• Sara Tingle

• Cognitive & Behavioral Psychologist in Macon, GA
• Providers in Macon, GA by specialty
• Cognitive & Behavioral Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2012; 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.