Organization
CENTURY FOOT CARE SPECIALISTS, P.C.
Active
Organization
CENTURY FOOT CARE SPECIALISTS, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISSETTE E TIRADO DPM (PRESIDENT)
(770) 935-4443
Entity
Organization
Contact information
Practice address
625 BEAVER RUIN RD NW, SUITE C, LILBURN, GA 30047-3467
(770) 935-4443
(770) 935-4475
Mailing address
625 BEAVER RUIN RD NW, SUITE C, LILBURN, GA 30047-3467
(770) 935-4443
(770) 935-4475
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
000729
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019971009A
—
GA
Enumeration date
08/11/2006
Last updated
10/22/2013
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