Russell, Tangella E
Russell, Tangella E is an individual health care provider with primary practice located at 1267 Highway 54 W Suite 2200, Fayetteville GA 30214-2114. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Russell, Tangella E can be contacted via phone (770) 716-0051.Contact Information
Primary practice address
1267 Highway 54 W Suite 2200
Fayetteville GA 30214-2114
Phone: (770) 716-0051
Fax: (770) 716-0087
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | RN 116405 | Georgia |
Profile Details
| NPI number | 1275637639 |
|---|---|
| LBN Legal business name | Russell, Tangella E |
| Credentials | Certified Nurse Practitioner (CNP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 7th, 2006 |
| Last updated | Sep 15th, 2010 - about 14 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 | 1275637639 | NPPES |
| Georgia | MEDICAID | 087974374G |
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