Russell, Bryan S

Russell, Bryan S is an individual health care provider with primary practice located at 55 Whitcher St Ste. 450, Marietta GA 30060. He recently has 2 registered licenses in different health care specialties including Podiatric Medicine & Surgery Service Providers / Podiatrist, Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery. Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery is his primary health care specialty. Russell, Bryan S can be contacted via phone (770) 590-4188.

Contact Information

Primary practice address
55 Whitcher St Ste. 450 Marietta GA 30060
Phone: (770) 590-4188
Fax: (770) 590-4189
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X POD001261 Georgia
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X POD001261 Georgia

Profile Details

NPI number 1700854825
LBN Legal business name Russell, Bryan S
Credentials DPM FACFAS
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 14th, 2006
Last updated Oct 30th, 2020 - about 5 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 1700854825 NPPES
Georgia MEDICAID 0003150721C

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