Individual
VERONICA RUSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
117 BRYAN ST W, DOUGLAS, GA 31533-5201
(912) 384-2555
Mailing address
117 BRYAN ST W, DOUGLAS, GA 31533-5201
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
004245
GA
Other
Enumeration date
05/10/2022
Last updated
03/07/2023
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