Individual
MICHAEL RUSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6600 VAN AALST BLVD, FORT BENNING, GA 31905-2102
(762) 408-0374
Mailing address
6600 VAN AALST BLVD, FORT BENNING, GA 31905-2102
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
01/13/2020
Last updated
04/27/2026
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