Individual
STEPHANIE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
415 N JACKSON ST, AMERICUS, GA 31709-3015
(229) 931-6988
Mailing address
2010 W BROAD AVE APT 124, ALBANY, GA 31707-5722
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
054311126
GA
Other
Enumeration date
12/12/2014
Last updated
12/12/2014
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