MEDICARE: NATHAN CARMAN TIRABASSI DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer
2	390200000X	Student in an Organized Health Care Education/Training Program
3	213E00000X	Podiatrist	POD305009	GA

General Provider Information

NPI Number	:	1225438328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN CARMAN TIRABASSI DPM

Provider Business Mailing Address
First Line	:	3200 HIGHLANDS PKWY SE STE 100
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30082-5192
Country	:	US
Telephone Number	:	770-319-5502
Fax Number	:	404-481-4452

Provider Business Practice Location Address
First Line	:	3200 HIGHLANDS PKWY SE STE 100
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30082-5192
Country	:	US
Telephone Number	:	770-319-5502
Fax Number	:	404-481-4452

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2014
Last Update Date	:	06/14/2024

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