Healthcare Provider Details

I. General information

NPI: 1336123843
Provider Name (Legal Business Name): RUSSELL D. SPRINGER PC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 HAWTHORNE AVE STE A
ATHENS GA
30606-2881
US

IV. Provider business mailing address

270 HAWTHORNE AVE
ATHENS GA
30606-2881
US

V. Phone/Fax

Practice location:
  • Phone: 706-543-3599
  • Fax:
Mailing address:
  • Phone: 706-543-3599
  • Fax: 706-543-8681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberGA01619
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT001619
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: