Individual
LAUREN H RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3903 S COBB DR SE STE 200, SMYRNA, GA 30080-6301
(770) 435-3214
Mailing address
3903 S COBB DR SE STE 200, SMYRNA, GA 30080-6301
(770) 435-3214
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
9747
GA
363AM0700X
Medical Physician Assistant
Primary
9747
GA
Other
Enumeration date
06/09/2020
Last updated
06/12/2020
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