Active NPI
James Cliffton Tillery, LPC, MAC, NCC
- Professional Counselor
- Norcross, GA
National Provider Identifier
1598891640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 002379
- Practice address
- 3936 Holcomb Bridge Rd
Norcross, GA 30092-2206 - Phone
- (404) 405-6838
- NPI assigned
- Feb 25, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 002379 | GA | Primary |
Addresses
Primary practice location
3936 Holcomb Bridge Rd
Norcross, GA 30092-2206
Mailing address
4520 Timber Path CT SW
Lilburn, GA 30047-8900
Phone (770) 806-8556
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
| License | State | Type | Specialty |
|---|---|---|---|
| 002379 | GA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1598891640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4520 TIMBER PATH CT SW",
"city": "LILBURN",
"state": "GA",
"postal_code": "300478900",
"telephone_number": "770-806-8556"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3936 HOLCOMB BRIDGE RD",
"city": "NORCROSS",
"state": "GA",
"postal_code": "300922206",
"telephone_number": "404-405-6838"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TILLERY",
"first_name": "JAMES",
"middle_name": "CLIFFTON",
"name_prefix": "Mr.",
"credential": "LPC, MAC, NCC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "002379",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Norcross, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.