Tyrisa Burdine, SPECIALIST
Individual provider Active NPI Prosthetics Case Management · Lithia Springs, GA
NPI 1184201782 · NPPES record last updated Mar 28, 2021
Key facts
- NPI
- 1184201782
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Prosthetics Case Management 1744P3200X
- License
- CO131275 (GA)
- Practice address
- 351 Thornton Rd Ste 118
Lithia Springs, GA 30122-1589 - Phone
- (865) 455-8410
- NPI assigned
- Mar 28, 2021
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CO131275 | GA | MD | Prosthetics Case Management |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthetics Case Management |
1744P3200X | CO131275 | GA | Yes |
Addresses
Primary practice location
351 Thornton Rd Ste 118
Lithia Springs, GA 30122-1589
Mailing address
351 Thornton Rd Ste 118
Lithia Springs, GA 30122-1589
Phone (865) 455-8410
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | website |
Other providers in Lithia Springs, GA
- Richard Allen Brook
- Bryce Brown
- Jennifer Brown
- Brooke N Browning
- Sally Brumbill
- Brenda J Lipscomb Burgess
- Claude Campbell Jr.
- Awana Carroll
- Felicia Rena Carter
- Stephen L Carter II
All providers in Lithia Springs, GA · Prosthetics Case Management in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 28, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.