Individual
AMY R RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
266 JOULE ST, ALCOA, TN 37701-2422
(865) 984-3864
(865) 380-4095
Mailing address
103 W BROADWAY AVE, MARYVILLE, TN 37801-4703
(865) 273-1752
(865) 273-1755
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
908
TN
363AM0700X
Medical Physician Assistant
908
TN
363AS0400X
Surgical Physician Assistant
908
TN
Other
Enumeration date
05/16/2006
Last updated
06/12/2020
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