Russell, Brian K.

Russell, Brian K. is an individual health care provider with primary practice located at 100 Mimosa Dr Ste 110 , Thomasville GA 31792-6676. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurological Surgery, which is considered as his primary health care specialty. Russell, Brian K. can be contacted via phone (850) 999-4894.

Contact Information

Primary practice address
100 Mimosa Dr Ste 110 Thomasville GA 31792-6676
Phone: (850) 999-4894
Fax: (850) 668-0572
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurological Surgery 207T00000X ME131234 Florida
Allopathic & Osteopathic Physicians / Neurological Surgery 207T00000X 036-078323 Illinois
Allopathic & Osteopathic Physicians / Neurological Surgery 207T00000X 076453 Georgia

Profile Details

NPI number 1396834271
LBN Legal business name Russell, Brian K.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 11th, 2006
Last updated Jan 4th, 2022 - about 3 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396834271 NPPES
Illinois MEDICAID 036078323

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