Individual
DOUGLAS BLANE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
439 US HWY 158 WEST, YANCEYVILLE, NC 27379
(336) 694-1181
Mailing address
5610 GROOMETOWN RD, HIGH POINT, HIGH POINT, NC 27263-9368
(336) 688-0928
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
103359
NC
Other
Enumeration date
04/10/2006
Last updated
10/05/2022
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