Individual
RUSSELL TREVENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1510 HUDSON BRIDGE RD, STOCKBRIDGE, GA 30281-5020
(404) 785-8660
(404) 785-8730
Mailing address
1510 HUDSON BRIDGE RD, STOCKBRIDGE, GA 30281-5020
(404) 785-8660
(404) 785-8730
Taxonomy
Speciality
Code
Description
License number
State
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
39251
GA
Other
Enumeration date
07/07/2006
Last updated
06/06/2022
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