Individual
BRYAN S RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM FACFAS
Contact information
Practice address
55 WHITCHER ST, STE. 450, MARIETTA, GA 30060
(770) 590-4188
(770) 590-4189
Mailing address
559 VINCENT ST, ATTN: 21 MDOS/SGOF - ORTHO, PETERSON AFB, CO 80914-1541
(719) 526-2273
(877) 813-1756
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
POD001261
GA
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
POD001261
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0003150721C
—
GA
Enumeration date
03/14/2006
Last updated
10/30/2020
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