Provider Demographics
NPI:1962457895
Name:FLINT, RUSSELL AUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:AUSTIN
Last Name:FLINT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:620 J L WHITE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-4896
Mailing Address - Country:US
Mailing Address - Phone:706-692-6980
Mailing Address - Fax:706-692-6982
Practice Address - Street 1:620 J L WHITE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4896
Practice Address - Country:US
Practice Address - Phone:706-692-6980
Practice Address - Fax:706-692-6982
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA031423207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I207948OtherMEDICARE
GA003108633BMedicaid