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General NPI Number Information
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NPI Number | 1255665170
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Entity Type | Organization
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Legal Business Name | PICKFORD MEDICAL SERVICES, LLC.
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Dates
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Enumeration Date | 09/24/2009
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 7810 MCGINNIS FERRY RD SUITE #108
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City | SUWANEE
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State | GA
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Zip | 30024-1633
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Country | US
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Telephone | 770-622-9446
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Fax |
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Provider Business Mailing Address
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Address Line | 7325 AMBERLEIGH WAY
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City | DULUTH
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State | GA
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Zip | 30097-1873
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Country | US
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Telephone | 404-514-4139
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. JILL RUSSELL
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Credential | M.D.
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Telephone | 770-622-9446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | GA
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