Provider Demographics
NPI:1306214507
Name:TILLMAN, ALANDA KNIGHT
Entity type:Individual
Prefix:MRS
First Name:ALANDA
Middle Name:KNIGHT
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 240
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39653-0240
Mailing Address - Country:US
Mailing Address - Phone:601-384-4532
Mailing Address - Fax:601-384-8334
Practice Address - Street 1:216 MAIN ST.
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:MS
Practice Address - Zip Code:39653-0240
Practice Address - Country:US
Practice Address - Phone:601-384-2051
Practice Address - Fax:601-384-8334
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00-652101744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management