BRYAN S RUSSELL (NPI# 1700854825) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700854825 |
| Entity Type | Individual |
| Full Name | BRYAN S RUSSELL |
| Credential | DPM FACFAS |
| Practice Address |
55 Whitcher St Ste. 450 Marietta GA 30060 |
| Mailing Address |
559 Vincent St Attn: 21 Mdos/sgof - Ortho Peterson Afb CO 80914-1541 |
| Practice Telephone | 7705904188 |
| Practice Fax Number | 7705904189 |
| Mailing Telephone | 7195262273 |
| Mailing Fax Number | 8778131756 |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2020-10-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 213E00000X | Podiatrist | POD001261 | GA | Podiatric Medicine & Surgery Service Providers |
| Y | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
POD001261 | GA | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 0003150721C | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 559 Vincent St, Attn: 21 Mdos/sgof - Ortho, Peterson Afb, CO 809141541 | 7195262273 | 8778131756 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407320260 | Bryan Clint Russell | Physical Medicine & Rehabilitation | 160 C Ave, Coronado, CA 92118-1420 | 2019-01-15 |
| 1558366781 | Bryan C Russell | Chiropractor | 12000 Lincoln Dr W, Suite 304, Marlton, NJ 08053-3402 | 2005-06-15 |
| 1750820569 | Bryan Russell | Peer Specialist | 32300 S 625 Rd, Grove, OK 74344-6285 | 2017-02-14 |
| 1841693330 | Bryan Lee Russell | Registered Nurse | 4040 Memorial Pkwy Sw, Huntsville, AL 35802-4364 | 2014-09-29 |
| 1497840219 | Bryan M Russell | Physical Therapist | 105 Collier Rd Nw, Suite 2000, Atlanta, GA 30309-1710 | 2006-10-04 |
| Street Address |
55 WHITCHER ST STE. 450 |
| City | MARIETTA |
| State | GA |
| Zip Code | 30060 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144845116 | Legacy Center for Spinal Surgery, LLC | Neurological Surgery | 1900 The Exchange, Ne, Suite 600, Marietta, GA 30060 | 2020-06-15 |
| 1407477193 | Michael Cynil Daniel | Counselor | 698 N Marietta, Pkwy, Marietta, GA 30060 | 2020-05-04 |
| 1285253401 | Cameron Thomas Kennelly | Student in an Organized Health Care Education/Training Program | 677 Church Street Ne Attn:gme, Marietta, GA 30060 | 2020-04-09 |
| 1922640739 | Jeremiah George Blair | Physician Assistant | 61 Whitcher St Suite 2100, Marietta, GA 30060 | 2019-10-14 |
| 1164064945 | Denise Alicia Mick | Registered Nurse | 677 Church St Wellstar Kennestone Hospital, Marietta, GA 30060 | 2019-10-12 |
| 1184283772 | Iora Health Georgia, P.C. | Internal Medicine | 280 Cobb Pkwy Se, Suite 60, Marietta, GA 30060 | 2019-06-07 |
| 1346703212 | Caitlin Virginia Mueller | Student in an Organized Health Care Education/Training Program | 677 Church Street Ne, Attn: Gme, Marietta, GA 30060 | 2019-04-08 |
| 1184187205 | Adero Francis | Student in an Organized Health Care Education/Training Program | Wellstar Kennestone Gme Internal Medicine Clinic, 833 Campbell Hill St Nw, Suite 250, Marietta, GA 30060 | 2019-04-08 |
| 1659832749 | Matthew Mozzo | Student in an Organized Health Care Education/Training Program | 677 Church Street / Lower Level, Gme Department / I.m., Marietta, GA 30060 | 2019-03-29 |
| 1245797430 | La'myia Spentz | Specialist | 109 Anderson St Ne, Suite 608, Marietta, GA 30060 | 2019-02-25 |
| Find all providers in zip 30060 | ||||
| Taxonomy Code | 213ES0103X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot & Ankle Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194184879 | Sequioa Ducasse | Podiatrist | 2550 Windy Hill Rd Se Ste 206, Marietta, GA 30067-8654 | 2016-02-23 |
| 1578946745 | Neha Delvadia | Podiatrist | 3901 Roswell Rd Ste 340, Marietta, GA 30062-6250 | 2015-07-06 |
| 1447653761 | Marie-christine Bergeron | Podiatrist | 3225 Shallowford Rd Ste 200, Marietta, GA 30062-1288 | 2014-10-01 |
| 1578856902 | Irene Cristina Verlezza | Podiatrist | 1200 Johnson Ferry Rd Ste 150, Marietta, GA 30068-5403 | 2011-05-18 |
| 1811019730 | Vivian Chizorom Iwu | Podiatrist | 540 Powder Springs St Ste B6, Marietta, GA 30064-3559 | 2007-04-03 |
| 1700981057 | Nathan Harold Schwartz | Podiatrist | 792 Church St Ne Ste 102, Marietta, GA 30060 | 2006-09-13 |
| 1497740229 | Mathew M. John | Podiatrist | 2790 Sandy Plains Rd, Suite 300, Marietta, GA 30066-4378 | 2005-09-19 |
| 1427055805 | Mark R. Light | Podiatrist | 4439 Roswell Rd, Marietta, GA 30062-6452 | 2005-06-30 |
| 1043827280 | Choice Podiatry Center, Inc. | Podiatrist | 540 Powder Springs St Ste B6, Marietta, GA 30064-3559 | 2020-09-30 |
| 1730721408 | Krishna Podiatry Group of Georgia | Podiatrist | 3901 Roswell Rd Ste 340, Marietta, GA 30062-6250 | 2019-10-14 |
| Find all providers in MARIETTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.