Healthcare Provider Details

I. General information

NPI: 1881618502
Provider Name (Legal Business Name): GERALD R. TILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S MEETING ST
GEORGETOWN SC
29440-3834
US

IV. Provider business mailing address

1200 HIGHMARKET ST
GEORGETOWN SC
29440-3227
US

V. Phone/Fax

Practice location:
  • Phone: 843-340-0561
  • Fax:
Mailing address:
  • Phone: 843-546-8421
  • Fax: 843-546-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD6038
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: