Provider Demographics
NPI:1003800665
Name:GORE, RUSSELL (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:
Last Name:GORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 PEACHTREE RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1426
Mailing Address - Country:US
Mailing Address - Phone:404-350-7323
Mailing Address - Fax:404-350-7694
Practice Address - Street 1:101 WOODRUFF CIR STE 6000
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-0001
Practice Address - Country:US
Practice Address - Phone:404-727-5004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0520722083A0100X
GA520722084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine