Provider Demographics
NPI:1013357458
Name:RUSSELL, HORACE AINSLEY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:HORACE
Middle Name:AINSLEY
Last Name:RUSSELL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 321359
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-1359
Mailing Address - Country:US
Mailing Address - Phone:601-936-1395
Mailing Address - Fax:
Practice Address - Street 1:161 RIVER OAKS DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-5375
Practice Address - Country:US
Practice Address - Phone:601-376-2832
Practice Address - Fax:601-376-1815
Is Sole Proprietor?:No
Enumeration Date:2013-06-30
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MST-2711207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine