Individual
MR. KEVIN D RUSSELL SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1351 GATES RD, COLUMBIA, MS 39429-8948
(601) 441-2515
(601) 736-3872
Mailing address
1351 GATES RD, COLUMBIA, MS 39429-8948
(601) 441-2515
(601) 736-3872
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
8878
MS
172A00000X
Driver
Primary
—
—
Other
Enumeration date
12/30/2014
Last updated
12/30/2014
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