Individual
ABIGAIL RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
142 GA STATE HIGHWAY 138, MONROE, GA 30655
(770) 207-1137
Mailing address
1016 GRANITE LN, LOGANVILLE, GA 30052-2377
(770) 554-6750
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA001474
LICENSE#
GA
Enumeration date
08/30/2006
Last updated
07/08/2007
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