Individual
KELLY RUSSIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
6325 SHANNON PKWY, SUITE D, UNION CITY, GA 30291-1538
(770) 964-1400
(770) 306-1343
Mailing address
6325 SHANNON PKWY, SUITE D, UNION CITY, GA 30291-1538
(770) 964-1400
(770) 306-1343
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004096
GA
Other
Enumeration date
12/13/2006
Last updated
07/26/2012
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