Organization
RUSSELL L. CARLISLE, D.O.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL CARLISLE D.O. (OWNER)
(601) 757-5791
Entity
Organization
Contact information
Practice address
333 WILLOW RIDGE CV, BRANDON, MS 39047-8089
(601) 757-5791
Mailing address
333 WILLOW RIDGE CV, BRANDON, MS 39047-8089
(601) 757-5791
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
15093
MS
Other
Enumeration date
02/11/2015
Last updated
02/11/2015
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