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General NPI Number Information
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NPI Number | 1710371117
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Entity Type | Individual
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Provider Name | BETHANY RUSSELL M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/24/2015
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Last Update Date | 05/02/2023
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Provider Practice Location Address
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Address Line | 1323 E WOOD ST
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City | PARIS
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State | TN
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Zip | 38242
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Country | US
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Telephone | 731-642-2011
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Fax | 731-644-2758
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Provider Business Mailing Address
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Address Line | 1323 E WOOD ST
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City | PARIS
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State | TN
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Zip | 38242-4421
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Country | US
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Telephone | 731-642-2011
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Fax | 731-644-2758
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 55361
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License Number State | TN
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