Individual
JESSICA LEE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
400 N 5TH AVE, ROME, GA 30165
(762) 470-0939
Mailing address
400 N 5TH AVE SW, ROME, GA 30165-2846
(762) 470-0939
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11714
GA
Other
Enumeration date
01/25/2023
Last updated
12/17/2025
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