Individual
ERA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
HAIR LOSS SPECIALIST
Contact information
Practice address
2170 W POINT RD, SUITE 36, LAGRANGE, GA 30240-4007
(762) 323-7874
Mailing address
2170 W POINT RD, SUITE 36, LAGRANGE, GA 30240-4007
(762) 323-7874
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
224P00000X
GA
225000000X
Orthotic Fitter
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7708
—
GA
Enumeration date
04/19/2016
Last updated
11/01/2021
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