MEDICARE: DR. ALEXANDRA LEIGH RUSSELL DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN123838	GA
2	1223G0001X	General Practice Dentistry	11336	SC

General Provider Information

NPI Number	:	1144110057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDRA LEIGH RUSSELL DMD

Provider Business Mailing Address
First Line	:	2549 WALTON WAY APT D1
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30904-4578
Country	:	US
Telephone Number	:	478-244-5102
Fax Number	:

Provider Business Practice Location Address
First Line	:	545 MULLINS COLONY DR
Second Line	:
City	:	EVANS
State	:	GA
Zip	:	30809-0559
Country	:	US
Telephone Number	:	706-842-2215
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2025
Last Update Date	:	03/12/2026

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