Organization
UNIVERSITY ORTHOPAEDIC ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE RUSSELL M.D. (ASSOCIATE PROFESSOR)
(601) 984-6525
Entity
Organization
Contact information
Practice address
1410 E WOODROW WILSON AVE, JACKSON, MS 39216-5114
(601) 984-6525
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
Taxonomy
Speciality
Code
Description
License number
State
207XX0801X
Orthopaedic Trauma Physician
Primary
16970
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0120719
—
MS
Enumeration date
02/27/2007
Last updated
08/22/2020
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