Provider Demographics
NPI:1023239977
Name:HINDS, RUSSELL DAVID (ATC)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:DAVID
Last Name:HINDS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2144 LAKESHORE DR APT 14A
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1029
Mailing Address - Country:US
Mailing Address - Phone:601-815-4613
Mailing Address - Fax:
Practice Address - Street 1:2144 LAKESHORE DR APT 14A
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1029
Practice Address - Country:US
Practice Address - Phone:601-815-4613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT0125174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist