Roberts, Russell
Roberts, Russell is an individual health care provider with primary practice located at 255 W 5Th St Sw Suite 150, Rome GA 30165-2817. He recently has 8 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Body Imaging, Allopathic & Osteopathic Physicians / Neuroradiology, Allopathic & Osteopathic Physicians / Nuclear Radiology, Allopathic & Osteopathic Physicians / Pediatric Radiology, Allopathic & Osteopathic Physicians / Diagnostic Radiology, Allopathic & Osteopathic Physicians / Therapeutic Radiology, Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology, Allopathic & Osteopathic Physicians / Diagnostic Ultrasound. Allopathic & Osteopathic Physicians / Diagnostic Radiology is his primary health care specialty. Roberts, Russell can be contacted via phone (706) 232-1545.Contact Information
Primary practice address
255 W 5Th St Sw Suite 150
Rome GA 30165-2817
Phone: (706) 232-1545
Fax: (706) 232-3819
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Body Imaging | 2085B0100X | 055958 | Georgia |
| Allopathic & Osteopathic Physicians / Neuroradiology | 2085N0700X | 055958 | Georgia |
| Allopathic & Osteopathic Physicians / Nuclear Radiology | 2085N0904X | 055958 | Georgia |
| Allopathic & Osteopathic Physicians / Pediatric Radiology | 2085P0229X | 055958 | Georgia |
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 055958 | Georgia |
| Allopathic & Osteopathic Physicians / Therapeutic Radiology | 2085R0203X | 055958 | Georgia |
| Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology | 2085R0204X | 055958 | Georgia |
| Allopathic & Osteopathic Physicians / Diagnostic Ultrasound | 2085U0001X | 055958 | Georgia |
Profile Details
| NPI number | 1548342843 |
|---|---|
| LBN Legal business name | Roberts, Russell |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 19th, 2006 |
| Last updated | Oct 28th, 2016 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1548342843 | NPPES |
| Georgia | Other | 393121 | BCBS OF GA |
| Georgia | Other | 581088318A | BCBS OF GA |
| Georgia | MEDICAID | 326530183A | BCBS OF GA |
| Georgia | Other | P00250939 | BCBS OF GA |
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