Provider Demographics
NPI:1134180656
Name:HINERMAN, RUSSELL WALKER (MD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:WALKER
Last Name:HINERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 HAWTHORNE PARK
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606
Mailing Address - Country:US
Mailing Address - Phone:706-548-0500
Mailing Address - Fax:706-548-3575
Practice Address - Street 1:220 HAWTHORNE PARK
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2148
Practice Address - Country:US
Practice Address - Phone:706-548-0500
Practice Address - Fax:706-548-3575
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME543162085R0001X
GA294682085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000344286CMedicaid
FL920006652OtherRAILROAD MEDICARE
FL2567024-00Medicaid
GA202I928592Medicare PIN
FLF02498Medicare UPIN
FL08995XMedicare PIN