Individual
MISS TEKI MASHAWN RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
444 CHESTLEHURST RD, SENOIA, GA 30276-2505
(770) 599-4500
(770) 599-4500
Mailing address
20 ELIZABETH RD, SENOIA, GA 30276-2524
(770) 599-4500
(770) 599-4500
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
OT002684
GA
Other
Enumeration date
02/06/2015
Last updated
06/09/2016
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