Individual
JESSICA RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
340 N MILLEDGE AVE STE B, ATHENS, GA 30601-3806
(706) 548-0008
Mailing address
340 N MILLEDGE AVE STE B, ATHENS, GA 30601-3806
Taxonomy
Speciality
Code
Description
License number
State
163WN0800X
Neuroscience Registered Nurse
RN239269
GA
363L00000X
Nurse Practitioner
Primary
RN239269
GA
Other
Enumeration date
11/03/2019
Last updated
09/21/2022
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