Provider Demographics
NPI:1811376098
Name:RUSSELL, ESTHER JACKSON (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ESTHER
Middle Name:JACKSON
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ESTHER
Other - Middle Name:JACKSON
Other - Last Name:POLATTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4355 BROWNS BRIDGE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-4554
Mailing Address - Country:US
Mailing Address - Phone:770-771-5050
Mailing Address - Fax:770-771-5051
Practice Address - Street 1:4355 BROWNS BRIDGE RD STE 1
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-4554
Practice Address - Country:US
Practice Address - Phone:770-771-5050
Practice Address - Fax:770-771-5051
Is Sole Proprietor?:No
Enumeration Date:2015-05-21
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN183800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily