Individual
MR. RUSSELL L PRIDGEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
588 KRISTIN LN, WINDER, GA 30680-3247
(410) 375-1996
(770) 867-1651
Mailing address
588 KRISTIN LN, WINDER, GA 30680-3247
(410) 375-1996
(770) 867-1651
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
057447391
GA
Other
Enumeration date
01/06/2016
Last updated
06/05/2016
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