Healthcare Provider Details

I. General information

NPI: 1124126099
Provider Name (Legal Business Name): RUSSELL A FRIEDMAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 ROSWELL RD SUITE A235
SANDY SPRINGS GA
30350-1826
US

IV. Provider business mailing address

8800 ROSWELL RD SUITE A235
SANDY SPRINGS GA
30350-1826
US

V. Phone/Fax

Practice location:
  • Phone: 770-641-9797
  • Fax: 770-641-9771
Mailing address:
  • Phone: 770-641-9797
  • Fax: 770-641-9771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR005683
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. RUSSELL A FRIEDMAN
Title or Position: PRESIDENT
Credential: DC
Phone: 770-641-9797