Individual
LISSETTE E. TIRADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.P.M.
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
213E00000X
Podiatrist
Primary
000729
GA
213ES0131X
Foot Surgery Podiatrist
000729
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000761736A
—
GA
Enumeration date
07/28/2005
Last updated
08/27/2013
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