Donald A Tillman, LCSW
Individual provider Active NPI Clinical Social Worker · Hillsboro, GA
NPI 1881665255 · NPPES record last updated Feb 7, 2011
Key facts
- NPI
- 1881665255
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 001384 (GA)
- Practice address
- 4637 Clay Tillman Rd
Hillsboro, GA 31038-3854 - Phone
- (706) 476-4616
- NPI assigned
- Feb 1, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001384 | GA | MD | Clinical Social Worker |
| 1384 | GA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Behavioral Care of Central Ga, PC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 001384 | GA | Yes |
Addresses
Primary practice location
4637 Clay Tillman Rd
Hillsboro, GA 31038-3854
Mailing address
4637 Clay Tillman Rd
Hillsboro, GA 31038-3854
Phone (706) 476-4616
Other providers in Hillsboro, GA
All providers in Hillsboro, GA · Clinical Social Worker in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 7, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.