Individual
ZACHARY RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, LAT, CSCS, OTC
Contact information
Practice address
1305 JENNINGS MILL ROAD, BUILDING 300, SUITE 110, WATKINSVILLE, GA 30677
(706) 613-5880
(706) 613-5880
Mailing address
5883 N NEVADA AVE, 324, COLORADO SPRINGS, CO 80918-3507
(678) 481-6519
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
AT003715
GA
390200000X
Student in an Organized Health Care Education/Training Program
0001416
CO
Other
Enumeration date
10/26/2015
Last updated
09/27/2019
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