Provider Demographics
NPI:1003640095
Name:RUSSELL, AKIM (MED)
Entity type:Individual
Prefix:MR
First Name:AKIM
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5134 FOLSOM ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-1528
Mailing Address - Country:US
Mailing Address - Phone:267-334-9461
Mailing Address - Fax:
Practice Address - Street 1:5134 FOLSOM ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-1528
Practice Address - Country:US
Practice Address - Phone:267-334-9461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical