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General NPI Number Information
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NPI Number | 1336114784
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Entity Type | Organization
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Legal Business Name | LARRY J RUSSELL
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Dates
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Enumeration Date | 02/21/2006
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Last Update Date | 01/14/2008
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Provider Practice Location Address
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Address Line | 1027 FLEMING STREET
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City | HENDERSONVILLE
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State | NC
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Zip | 28791
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Country | US
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Telephone | 828-692-5781
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Fax | 828-696-8606
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Provider Business Mailing Address
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Address Line | 1027 FLEMING STREET
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City | HENDERSONVILLE
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State | NC
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Zip | 28791
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Country | US
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Telephone | 828-692-5781
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Fax | 828-696-8606
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | LAURA H WARD
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Credential |
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Telephone | 828-692-5781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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