Individual
DR. BRIAN K. RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 MIMOSA DR STE 110, THOMASVILLE, GA 31792-6676
(850) 999-4894
(850) 668-0572
Mailing address
3445 BANNERMAN RD STE 200, TALLAHASSEE, FL 32312-7053
(850) 999-4894
(850) 668-0572
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
036-078323
IL
207T00000X
Neurological Surgery Physician
Primary
076453
GA
207T00000X
Neurological Surgery Physician
ME131234
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036078323
—
IL
Enumeration date
10/11/2006
Last updated
01/04/2022
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