Healthcare Provider Details

I. General information

NPI: 1952369365
Provider Name (Legal Business Name): WILLIAM F. TILLMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12010 OLD MOUNTAIN PARK RD NE
ROSWELL GA
30075-1716
US

IV. Provider business mailing address

12010 OLD MOUNTAIN PARK RD NE
ROSWELL GA
30075-1716
US

V. Phone/Fax

Practice location:
  • Phone: 770-587-4948
  • Fax: 770-587-4948
Mailing address:
  • Phone: 770-587-4948
  • Fax: 770-587-4948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number018191
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: