Individual
LORI RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
100 HUNTERS LN, SUITE 100, TULLAHOMA, TN 37388-8263
(931) 455-4616
(931) 455-2362
Mailing address
100 HUNTERS LN, SUITE 100, TULLAHOMA, TN 37388-8263
(931) 455-4616
(931) 455-2362
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1198
TN
Other
Enumeration date
05/27/2005
Last updated
07/06/2012
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