Provider Demographics
NPI:1285656538
Name:RUSSELL, DEE B (MD)
Entity Type:Individual
Prefix:
First Name:DEE
Middle Name:B
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:420 E 2ND AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3224
Mailing Address - Country:US
Mailing Address - Phone:706-509-3000
Mailing Address - Fax:706-509-4608
Practice Address - Street 1:304 SHORTER AVE NW
Practice Address - Street 2:SUITE 201
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-4290
Practice Address - Country:US
Practice Address - Phone:706-509-3300
Practice Address - Fax:706-509-4596
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-05-15
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Provider Licenses
StateLicense IDTaxonomies
GA019593207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00182421AMedicaid
GAD42413Medicare UPIN