Individual
JOANN RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2540 WINDY HILL RD SE, MARIETTA, GA 30067-8605
(770) 644-1274
Mailing address
PO BOX 932840, ATLANTA, GA 31193-2840
(800) 749-2940
(706) 660-1454
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN049042
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
738385939A
—
GA
01
—
GRP757
MEDICARE GROUP
GA
Enumeration date
09/20/2006
Last updated
01/29/2012
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