Individual
KEITH PERRY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 STATE HIGHWAY 30 W, NEW ALBANY, MS 38652-3112
(800) 889-8610
(601) 982-7909
Mailing address
PO BOX 4767, JACKSON, MS 39296-4767
(800) 889-8610
(601) 982-7909
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
24818
MS
2085R0202X
Diagnostic Radiology Physician
T-2483
MS
Other
Enumeration date
07/06/2011
Last updated
09/27/2023
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