Individual
RUSSELL TALMAGE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1190 S 18TH STREET EXT, OXFORD, MS 38655-5378
(662) 234-0424
(662) 234-0485
Mailing address
1207 OLD LAKE CV, OXFORD, MS 38655-8152
(662) 236-2368
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT0217
MS
Other
Enumeration date
07/06/2006
Last updated
07/08/2007
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