Provider Demographics
NPI:1396040945
Name:GARNER, RUSSELL HINTON III (PTA)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:HINTON
Last Name:GARNER
Suffix:III
Gender:M
Credentials:PTA
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Mailing Address - Street 1:108 CLINTON PKWY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4730
Mailing Address - Country:US
Mailing Address - Phone:601-926-2018
Mailing Address - Fax:601-924-9746
Practice Address - Street 1:108 CLINTON PKWY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4730
Practice Address - Country:US
Practice Address - Phone:601-926-2018
Practice Address - Fax:601-924-9746
Is Sole Proprietor?:No
Enumeration Date:2011-01-12
Last Update Date:2015-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MSPTA3976225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant