Individual
LONNIE NICHOLAS RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
660 CHEROKEE ST NE STE 100, MARIETTA, GA 30060-8930
(678) 797-8201
Mailing address
450 14TH ST NW, ATLANTA, GA 30318-7963
(843) 291-2836
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
88192
GA
Other
Enumeration date
04/03/2019
Last updated
09/27/2023
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