Provider Demographics
NPI:1265428312
Name:TIRADO, EDWIN B JR (MD)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:B
Last Name:TIRADO
Suffix:JR
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:770-219-8440
Practice Address - Street 1:1315 JESSE JEWELL PKWY NE
Practice Address - Street 2:SUITE #110
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3822
Practice Address - Country:US
Practice Address - Phone:770-219-0023
Practice Address - Fax:770-219-0694
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2020-10-13
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Provider Licenses
StateLicense IDTaxonomies
GA061866207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H99630Medicare UPIN