Provider Demographics
NPI:1396945572
Name:RUSSELL, JAMES D II (PSYD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:RUSSELL
Suffix:II
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 HILLCREST RD NW STE 400
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-6893
Mailing Address - Country:US
Mailing Address - Phone:678-318-1730
Mailing Address - Fax:470-422-7134
Practice Address - Street 1:630 HILLCREST RD NW STE 400
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-6893
Practice Address - Country:US
Practice Address - Phone:678-318-1730
Practice Address - Fax:470-422-7134
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY2884103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA549472283AMedicaid