Individual
DR. NATALIE RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
55 CARLTON ST, ATHENS, GA 30602-1526
(706) 542-8621
(706) 583-0217
Mailing address
55 CARLTON ST, ATHENS, GA 30602-1526
(706) 542-8621
(706) 583-0217
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
029772
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00355396C
—
GA
Enumeration date
02/04/2008
Last updated
11/03/2009
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