Individual
COLIN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
169 ASHLEY AVE RM 202, CHARLESTON, SC 29425-8905
(240) 446-3263
Mailing address
441 MEETING ST APT 347, CHARLESTON, SC 29403-7819
(410) 842-5263
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
LL52729
SC
Other
Enumeration date
06/16/2018
Last updated
06/16/2018
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