DR. RUSSELL G. ANDERSON JR. (NPI# 1811068620) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811068620 |
| Entity Type | Individual |
| Full Name | DR. RUSSELL G. ANDERSON JR. |
| Credential | D.M.D. |
| Practice Address |
1415 Wooten Lake Rd Nw Suite 300 Kennesaw GA 30144-1350 |
| Practice Telephone | 7704192535 |
| Practice Fax Number | 7704190030 |
| Mailing Telephone | 7704192535 |
| Mailing Fax Number | 7704190030 |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
011457 | GA | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740895473 | Russell Dan Anderson | Registered Nurse | 4428 Sw 105th Dr, Gainesville, FL 32608-7139 | 2020-09-10 |
| 1124328794 | Russell E Anderson | Pharmacist | 1258 S Route 12, Fox Lake, IL 60020-1950 | 2010-10-28 |
| 1760538037 | Russell Lee Anderson | Family Medicine | 78270 Highway 1081, Covington, LA 70435-4646 | 2007-01-26 |
| 1801963376 | Russell Anderson | Internal Medicine | 514 North Brightleaf Blvd Suite 1100, Smithfield, NC 27577 | 2006-11-29 |
| 1982228235 | Russell Anderson | Psychologist | 2810 E Causeway Approach, Mandeville, LA 70448-3502 | 2020-06-02 |
| 1972965937 | Russell Anderson | Social Worker | 150 Shoup Ave, Idaho Falls, ID 83402-3657 | 2016-03-28 |
| 1548407513 | Russell Steven Anderson | Family Medicine | 1550 N Main St, Suite E, Layton, UT 84041-1757 | 2009-01-13 |
| 1619175288 | Russell N Anderson | Chiropractor | 20825 South St, Suite A, Tehachapi, CA 93561-6438 | 2007-07-05 |
| 1689885436 | Russell L. Anderson | Orthopaedic Surgery | 1150 45th St, West Palm Beach, FL 33407-2361 | 2007-05-24 |
| 1609097260 | Russell D Anderson | Chiropractor | 128 North Oakwood Road, Enid, OK 73703-4946 | 2007-05-01 |
| Street Address |
1415 WOOTEN LAKE RD NW SUITE 300 |
| City | KENNESAW |
| State | GA |
| Zip Code | 30144-1350 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467421073 | Chris Hobson | Optometrist | 1415 Wooten Lake Rd Nw, Suite 100, Kennesaw, GA 30144-1350 | 2006-03-16 |
| 1023557931 | Ryan Chihien Tieu | Optometrist | 1415 Wooten Lake Rd Nw, Kennesaw, GA 30144-1336 | 2017-02-13 |
| 1396066072 | Jonathan Woolfson Md, PC | Ophthalmology | 1415 Wooten Lake Rd Nw, Suite 100, Kennesaw, GA 30144-1336 | 2010-06-17 |
| 1174772859 | Georgia Ophthalmology Referral Center, LLC | Ophthalmology | 1415 Wooten Lake Rd Nw, Suite 130, Kennesaw, GA 30144-1336 | 2008-09-17 |
| 1043349368 | Tasman Eye Consultants PC | Optometrist | 1415 Wooten Lake Rd Nw, Suite 100, Kennesaw, GA 30144-1336 | 2007-03-04 |
| 1841361920 | H & T Eye Group, LLC | Optometrist | 1415 Wooten Lake Rd Nw, Kennesaw, GA 30144-1350 | 2006-11-13 |
| 1073548426 | Stuart R Tasman | Optometrist | 1415 Wooten Lake Rd Nw, Kennesaw, GA 30144-1350 | 2006-07-12 |
| 1699709246 | Heather Zutaut | Optometrist | 1415 Wooten Lake Rd Nw, Kennesaw, GA 30144-1350 | 2006-07-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205440054 | Physician Assistant Surgical Solutions | Surgery | 4290 Bells Ferry Road, Suite 134 - 1032, Kennesaw, GA 30144 | 2020-08-31 |
| 1487149340 | Creative Family Care Inc. | Social Worker | 1275 Shiloh Rd Nw Ste 3030, Kennesaw, GA 30144 | 2018-06-24 |
| 1033632203 | Octavio Andres Tobar | Specialist/Technologist | 1950 Barrett Lakes Blvd Nw Apt 1213, Kennesaw, GA 30144 | 2017-07-19 |
| 1851829220 | Sharon Mcmillan | Counselor | 1301 Shiloh Rd Nw Ste 1840, Kennesaw, GA 30144 | 2017-05-31 |
| 1073054680 | Metropolitan Health Care Plus Inc | Home Health | 445 Laurian Way, Kennesaw, GA 30144 | 2017-03-15 |
| 1649627969 | Caresouth Hha Holdings of Gainesville, LLC | Hospice Care, Community Based | 1000 Cobb Place Blvd Nw Ste 310, Kennesaw, GA 30144 | 2016-05-17 |
| 1851745988 | Joseph Mulligan | Social Worker | 1301 Shiloh Rd., Ste. 849, Kennesaw, GA 30144 | 2016-04-14 |
| 1629438601 | Youfit Health Clubs | Clinic/Center | 3895 Cherokee St Suite 100, Kennesaw, GA 30144 | 2016-03-03 |
| 1598156317 | Jodie Evans | Specialist | 1925 Vaughn Rd, Ste 200, Kennesaw, GA 30144 | 2015-02-16 |
| 1912302134 | Sleepmed Therapies, Inc. | Durable Medical Equipment & Medical Supplies | 1000 Cobb Place Blvd Nw Ste 510, Kennesaw, GA 30144 | 2014-10-30 |
| Find all providers in zip 30144 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467006510 | Ronald Edward Durie Jr. | Dentist | 1955 N Cobb Pkwy Nw Ste 110, Kennesaw, GA 30152-4503 | 2019-07-27 |
| 1437636321 | Jetoria Irving | Dentist | 1200 Ernest W Barrett Pkwy Nw Ste 200, Kennesaw, GA 30144-4513 | 2018-07-24 |
| 1184143059 | Kennesaw Mountain Dental Associates | Dentist | 1815 Old 41 Hwy, Ste 310, Kennesaw, GA 30152 | 2017-09-12 |
| 1366602286 | David Molina | Dentist | 4290 Bells Ferry Rd Nw Ste 136, Kennesaw, GA 30144-1768 | 2008-06-13 |
| 1770788572 | Tia Harding | Dentist | 5255 Stilesboro Rd Nw Ste 150, Kennesaw, GA 30152-7738 | 2007-06-20 |
| 1952502528 | Lizzette Garcia Edge | Dentist | 3420 Acworth Due West Rd Nw Ste A, Kennesaw, GA 30144-2371 | 2007-05-30 |
| 1265643977 | Edge Center for Family Dentistry | Dentist | 3420 Acworth Due West Rd, Suite A, Kennesaw, GA 30144 | 2007-05-24 |
| 1710003488 | Bruce A. Hester, D.m.d., P.C. | Dentist | 2980 Lewis St Nw, Kennesaw, GA 30144-5635 | 2007-03-22 |
| 1871617647 | Douglas Jay Deuchar | Dentist | 3903 Jiles Rd., Building 100, Suite 111, Kennesaw, GA 30144 | 2007-03-19 |
| 1326194861 | Patsy Usberghi | Dentist | 2105 Barrett Park Dr Nw, Kennesaw, GA 30144-7080 | 2007-01-26 |
| Find all providers in KENNESAW | ||||
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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.