Healthcare Provider Details

I. General information

NPI: 1720017577
Provider Name (Legal Business Name): TODD D TILLMANNS M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7945 WOLF RIVER BOULEVARD
GERMANTOWN TN
38138
US

IV. Provider business mailing address

7945 WOLF RIVER BOULEVARD
GERMANTOWN TN
38138
US

V. Phone/Fax

Practice location:
  • Phone: 901-683-0055
  • Fax: 901-922-6701
Mailing address:
  • Phone: 901-683-0055
  • Fax: 901-922-6701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number18211
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number37514
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: