Healthcare Provider Details

I. General information

NPI: 1609397686
Provider Name (Legal Business Name): WILLIAM H TILLMAN III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2419 GORDON SMITH DR
MOBILE AL
36617-2318
US

IV. Provider business mailing address

1015 MONTLIMAR DR STE A210
MOBILE AL
36609-1743
US

V. Phone/Fax

Practice location:
  • Phone: 251-434-3475
  • Fax: 251-450-4323
Mailing address:
  • Phone: 251-461-4243
  • Fax: 251-450-4323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number39828
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: