Healthcare Provider Details

I. General information

NPI: 1780851170
Provider Name (Legal Business Name): RUSSELL D SPRINGER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 10/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HAWTHORNE AVE STE A
ATHENS GA
30606-2168
US

IV. Provider business mailing address

1000 HAWTHORNE AVE STE A
ATHENS GA
30606-2168
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number001619
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RUSSELL DOUGLAS SPRINGER
Title or Position: CEO
Credential: O.D.
Phone: 706-543-3599