Healthcare Provider Details

I. General information

NPI: 1518895523
Provider Name (Legal Business Name): TILLMAN ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 WASHINGTON ST
JEFFERSON GA
30549-6660
US

IV. Provider business mailing address

PO BOX 54
HOSCHTON GA
30548-0054
US

V. Phone/Fax

Practice location:
  • Phone: 762-445-4925
  • Fax:
Mailing address:
  • Phone: 762-445-4925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name: SHARESA LASHUN TILLMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 762-445-4925