Individual
BYRON RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
713 RONIE ST, HATTIESBURG, MS 39401-4345
(601) 583-9401
Mailing address
713 RONIE ST, HATTIESBURG, MS 39401-4345
(601) 583-9401
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
—
—
372600000X
Adult Companion
—
—
3747P1801X
Personal Care Attendant
Primary
—
—
376J00000X
Homemaker
—
—
Other
Enumeration date
04/09/2015
Last updated
04/09/2015
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