Russell, Gregg E
Russell, Gregg E is an individual health care provider with primary practice located at 895 Canton Rd Ne Building 100, Marietta GA 30060-8934. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Russell, Gregg E can be contacted via phone (770) 427-8111.Contact Information
Primary practice address
895 Canton Rd Ne Building 100
Marietta GA 30060-8934
Phone: (770) 427-8111
Fax: (770) 499-1643
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 001349 | Georgia |
Profile Details
| NPI number | 1487656237 |
|---|---|
| LBN Legal business name | Russell, Gregg E |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 11th, 2005 |
| Last updated | Jul 8th, 2007 - about 17 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 | 1487656237 | NPPES |
| Georgia | MEDICAID | 000515787W |
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