Individual
DR. GABRIEL RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1044 AVALON PKWY, MCDONOUGH, GA 30253-7661
(770) 898-7078
(770) 898-7160
Mailing address
1950 OLD GALLOWS RD STE 520, VIENNA, VA 22182-3970
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OEG003445
PA
152W00000X
Optometrist
Primary
OPT003277
GA
Other
Enumeration date
07/27/2018
Last updated
03/23/2021
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