Individual
MRS. SONEA MARIA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
WILLOWOOD NURSING CENTER, 4595 CANTRELL ROAD, FLOWERY BRANCH, GA 30542
(770) 965-1484
Mailing address
1659 DOC MCLOCKLIN RD, STATHAM, GA 30666-2521
(770) 725-0659
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
001984
GA
Other
Enumeration date
04/26/2007
Last updated
07/08/2007
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