Wilson, Russell Andrew
Wilson, Russell Andrew is an individual health care provider with primary practice located at 1265 Highway 54 W Ste 500B , Fayetteville GA 30214-4556. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Wilson, Russell Andrew can be contacted via phone (770) 719-5660.Contact Information
Primary practice address
1265 Highway 54 W Ste 500B
Fayetteville GA 30214-4556
Phone: (770) 719-5660
Fax: (678) 336-5955
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 040590 | Georgia |
Profile Details
| NPI number | 1427057736 |
|---|---|
| LBN Legal business name | Wilson, Russell Andrew |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 19th, 2005 |
| Last updated | Jul 21st, 2020 - about 4 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 | 1427057736 | NPPES |
| Georgia | Other | P00081030 | RAILROAD MEDICARE |
| Georgia | MEDICAID | 00711389C | RAILROAD MEDICARE |
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