MEDICARE: CHRIS B. RUSSELL M.D., P.C.

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	261QP2300X	Primary Care Clinic/Center	15044	AL

General Provider Information

NPI Number	:	1386784007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRIS B. RUSSELL M.D., P.C.

Provider Business Mailing Address
First Line	:	204 LOWE AVE SE
Second Line	:	SUITE 6, BLDG 2
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-4262
Country	:	US
Telephone Number	:	256-533-0856
Fax Number	:	256-533-7981

Provider Business Practice Location Address
First Line	:	204 LOWE AVE SE
Second Line	:	SUITE 6, BLDG 2
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-4262
Country	:	US
Telephone Number	:	256-533-0856
Fax Number	:	256-533-7981

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHRIS B RUSSELL
Credential	:	M.D.
Telephone Number	:	256-533-0856

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	08/22/2020

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