Individual
MR. STEVEN L RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
191 RUTLEDGE AVE, CHARLESTON, SC 29403-5822
(843) 723-1614
(843) 727-2980
Mailing address
191 RUTLEDGE AVE, CHARLESTON, SC 29403-5822
(843) 723-1614
(843) 727-2980
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
A281
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0264PA
—
SC
Enumeration date
10/11/2006
Last updated
07/09/2007
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