Individual
HEATHER LYNN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
120 HAWTHORNE PARK, ATHENS, GA 30606
(776) 353-8700
(706) 353-6629
Mailing address
PO BOX 161463, ATLANTA, GA 30321-1463
(776) 369-5440
(706) 369-5490
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
008051
GA
Other
Enumeration date
08/08/2016
Last updated
06/11/2018
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