Provider Demographics
NPI:1639678402
Name:MCLEMORE, RUSSETT (DC)
Entity type:Individual
Prefix:DR
First Name:RUSSETT
Middle Name:
Last Name:MCLEMORE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 RACETRACK RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-6835
Mailing Address - Country:US
Mailing Address - Phone:770-789-2019
Mailing Address - Fax:
Practice Address - Street 1:308 RACETRACK RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-6835
Practice Address - Country:US
Practice Address - Phone:770-400-6750
Practice Address - Fax:706-400-6403
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009914111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor