Healthcare Provider Details

I. General information

NPI: 1710935663
Provider Name (Legal Business Name): ROBERT BURKE RUSSELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 L V STABLER DR
GREENVILLE AL
36037-3850
US

IV. Provider business mailing address

PO BOX 689022
FRANKLIN TN
37068-9022
US

V. Phone/Fax

Practice location:
  • Phone: 251-968-7474
  • Fax:
Mailing address:
  • Phone: 615-778-8468
  • Fax: 615-778-8468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number00004219
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: