Individual
CATHERINE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSN, PMHNP
Contact information
Practice address
126 ENTERPRISE PATH, HIRAM, GA 30141-2656
(678) 567-0920
Mailing address
126 ENTERPRISE PATH, HIRAM, GA 30141-2656
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
206715
GA
Other
Enumeration date
08/04/2020
Last updated
08/04/2020
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