MEDICARE: MR. GEORGE EDWARD TILLEY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C003070	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13006	OTHER	NC	BLUE CROSS AND BLUE SHIEL
2	132A0	OTHER	NC	BLUE CROSS/BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356320790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE EDWARD TILLEY LCSW

Provider Business Mailing Address
First Line	:	3117 WHITING AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-1648
Country	:	US
Telephone Number	:	910-508-7400
Fax Number	:

Provider Business Practice Location Address
First Line	:	3117 WHITING AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-1648
Country	:	US
Telephone Number	:	910-508-7400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	02/03/2026

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