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General NPI Number Information
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NPI Number | 1326304478
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Entity Type | Individual
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Provider Name | MADELINE RHEA RUSSELL M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/03/2012
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Last Update Date | 06/18/2019
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Provider Practice Location Address
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Address Line | 1010 MEDICAL CENTER DR STE 100
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City | HARDEEVILLE
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State | SC
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Zip | 29927-3452
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Country | US
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Telephone | 912-303-4200
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Fax | 912-790-2701
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Provider Business Mailing Address
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Address Line | 1139 LEXINGTON AVE
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City | SAVANNAH
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State | GA
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Zip | 31404-5502
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Country | US
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Telephone | 912-303-4200
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Fax | 912-790-2701
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 081226
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 52394
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License Number State | SC
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