Individual
JOI LEAH RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
175 GWINNETT DR, LAWRENCEVILLE, GA 30046-8444
(678) 209-2394
Mailing address
313 MANSFIELD WAY, STOCKBRIDGE, GA 30281-1579
(404) 539-5932
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
098493
GA
Other
Enumeration date
03/07/2022
Last updated
03/07/2022
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