# RICKY RUSSELL, M.D. LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912049487
- **Authorized official:** DR. RICKY GORDON RUSSELL M.D. (PHYSICIAN)
- **Authorized official phone:** (601) 985-9120

## Contact information

- **Practice address:** 501 MARSHALL ST, SUITE 603, JACKSON, MS 39202-1651
- **Practice address phone:** (601) 985-9120
- **Practice address fax:** (601) 985-9122
- **Mailing address:** 501 MARSHALL ST, SUITE 603, JACKSON, MS 39202-1651
- **Mailing address phone:** (601) 985-9120
- **Mailing address fax:** (601) 985-9122

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/13/2007
- **Last updated:** 01/29/2014