Healthcare Provider Details

I. General information

NPI: 1962457895
Provider Name (Legal Business Name): RUSSELL AUSTIN FLINT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 J L WHITE DR SUITE 100
JASPER GA
30143-4896
US

IV. Provider business mailing address

620 J L WHITE DR SUITE 100
JASPER GA
30143-4896
US

V. Phone/Fax

Practice location:
  • Phone: 706-692-6980
  • Fax: 706-692-6982
Mailing address:
  • Phone: 706-692-6980
  • Fax: 706-692-6982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number031423
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: