Provider Demographics
NPI:1184885816
Name:LENDERMON, RUSSELL DARREN (MD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:DARREN
Last Name:LENDERMON
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 1:3204 SWEET MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-8108
Mailing Address - Country:US
Mailing Address - Phone:501-605-6186
Mailing Address - Fax:
Practice Address - Street 1:3204 SWEET MEADOW CT
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-8108
Practice Address - Country:US
Practice Address - Phone:501-605-6186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003122207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine