Dr. Clifford Randolph Tillman
Gastroenterologist
107 Front St Suite 2126
Vidalia
, Louisiana 71373-2836
Dr. Clifford Randolph Tillman
Gastroenterologist
107 Front St Suite 2126
Vidalia
, Louisiana 71373-2836
(318) 336-2216
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About
Features
Specialties
- Gastroenterologist
Languages spoken
- English
Location
First Address
- Dr. Clifford Randolph Tillman
- 107 Front St Suite 2126
- Vidalia, LA
- Zip : 71373-2836
- Phone : (318) 336-2216
Second Address
- Dr. Clifford Randolph Tillman
- 107 Front St Suite 2126
- Vidalia, LA
- Zip : 71373-2836
- Fax : (318) 336-6074
- Phone : (318) 336-2216
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207RG0100X | Gastroenterologist | 06980R | LA |
National Provider Identifier
| NPI | 1053309732 |
|---|---|
| Provider Name | Dr. Clifford Randolph Tillman |
| First Address | Vidalia, LA 71373-2836 |
| Second Address | Vidalia, LA 71373-2836 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 07/10/2005 |
| Last Update Date | 25/07/2008 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 0115585 | (05) | MS |
| 1316521 | (05) | LA |
| C48308 | (02) | MS |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.