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Individual

RUSSELL PRUITT HERRINGTON SR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
4800 48TH STREET, VALLEY, AL 36854-3666
(334) 756-9180
(334) 756-5874
Mailing address
660 SNOOPY LANE, PORTAL, GA 30450
(912) 865-9353
(912) 865-4175

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
31261
GA
207Q00000X
Family Medicine Physician
031261
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000400188E
GA
05
000400188H
GA
05
178575873A
GA
01
P00400815
RAILROAD MEDICARE
GA
Enumeration date
07/19/2006
Last updated
08/11/2011
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