MEDICARE: DR. STEPHANIE L. RUSS-BARBER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	051725	GA
2	208000000X	Pediatrics Physician	TL28480	SC
3	208000000X	Pediatrics Physician	48935	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265405468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE L. RUSS-BARBER MD

Provider Business Mailing Address
First Line	:	1275 DICK LONAS RD UNIT 101
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-1383
Country	:	US
Telephone Number	:	865-500-2144
Fax Number	:	865-584-1363

Provider Business Practice Location Address
First Line	:	2587 WILLOW POINT WAY
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37931-3162
Country	:	US
Telephone Number	:	865-470-2560
Fax Number	:	865-691-5883

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	12/18/2019

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Directions to “ DR. STEPHANIE L. RUSS-BARBER MD” Practice Location

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