Provider Demographics
NPI:1225438328
Name:TIRABASSI, NATHAN CARMAN (DPM)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:CARMAN
Last Name:TIRABASSI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 HIGHLANDS PKWY SE STE 100
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-5192
Mailing Address - Country:US
Mailing Address - Phone:770-319-5502
Mailing Address - Fax:404-481-4452
Practice Address - Street 1:3200 HIGHLANDS PKWY SE STE 100
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-5192
Practice Address - Country:US
Practice Address - Phone:770-319-5502
Practice Address - Fax:404-481-4452
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X, 390200000X
GAPOD305009213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program