Healthcare Provider Details

I. General information

NPI: 1598458440
Provider Name (Legal Business Name): ENSLEY DANIELLE RUSSELL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 06/24/2023
Certification Date: 06/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 CENTER ST
COLUMBUS GA
31901-1527
US

IV. Provider business mailing address

6805 GAINES CREEK RD
COLUMBUS GA
31904-3324
US

V. Phone/Fax

Practice location:
  • Phone: 706-571-1000
  • Fax:
Mailing address:
  • Phone: 334-703-0795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberRN191163
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: