Provider Demographics
NPI:1922260066
Name:RUSSELL, DUSTIN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:LEE
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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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 ROAD
Practice Address - Street 2:SUITE 1 & 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:2008-06-30
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA066541207P00000X
GA66541207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine