| Organization Name: | CENTURY FOOT CARE SPECIALISTS, P.C. |
| NPI Number: | 1164433272 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LISSETTE E TIRADO (PRESIDENT) |
| Mailing Address: | 625 Beaver Ruin Rd Nw Suite C Lilburn |
| State: | GA US |
| Postal Code: | 300473467 |
| Phone Number: | 7709354443 |
| Fax Number: | 7709354475 |
| NPI Enumeration Date: | 08/11/2006 |
| NPI Last Update Date: | 10/22/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0131X |
| License Number: | 000729 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot Surgery |
| Taxonomy Definition: | |