Individual
KAYLA E'LISHA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1350 WALTON WAY, AUGUSTA, GA 30901-2612
(706) 774-5795
Mailing address
1350 WALTON WAY, AUGUSTA, GA 30901-2612
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12384
GA
Other
Enumeration date
05/07/2024
Last updated
04/15/2026
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