Healthcare Provider Details

I. General information

NPI: 1689374134
Provider Name (Legal Business Name): ERICA DOSTIE RUSSO-ALESI FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2023
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5470 MARTHA BERRY HWY NE
ARMUCHEE GA
30105-2302
US

IV. Provider business mailing address

221 TECHNOLOGY PKWY NW
ROME GA
30165-1369
US

V. Phone/Fax

Practice location:
  • Phone: 762-235-3830
  • Fax: 706-291-9391
Mailing address:
  • Phone: 762-235-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN258303
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: