Provider Demographics
NPI:1093078305
Name:SANCHEZ RUSSO, ROSSANA LUCIA (MD)
Entity Type:Individual
Prefix:
First Name:ROSSANA
Middle Name:LUCIA
Last Name:SANCHEZ RUSSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 CLIFTON ROAD, NE
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30322
Mailing Address - Country:US
Mailing Address - Phone:404-778-8488
Mailing Address - Fax:
Practice Address - Street 1:1365 CLIFTON RD NE STE 2200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-5307
Practice Address - Country:US
Practice Address - Phone:404-778-8488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA72115207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)