Individual
DR. TIMOTHY GLENN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 798-8768
Mailing address
965 RIDGE LAKE BLVD STE 315, MEMPHIS, TN 38120-9401
(901) 227-7015
(901) 227-8591
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
28048
MS
208D00000X
General Practice Physician
28944
NE
Other
Enumeration date
02/10/2014
Last updated
12/17/2024
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