Individual
DR. WILLIAM S RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-8908
(843) 792-1414
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
Taxonomy
Speciality
Code
Description
License number
State
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
TL30753
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009986805
—
AL
01
—
051527621
BCBS PROVIDER NUMBER
AL
Enumeration date
10/06/2005
Last updated
10/22/2020
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