Provider Demographics
NPI:1609866839
Name:RUSSELL, CHRISTOPHER S (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:S
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTOPHER
Other - Middle Name:S
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:95 COLLIER RD
Mailing Address - Street 2:SUITE 4045 PEACHTREE NEUROLOGICAL CLINIC, P.C.
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309
Mailing Address - Country:US
Mailing Address - Phone:404-351-2270
Mailing Address - Fax:404-352-1969
Practice Address - Street 1:95 COLLIER RD
Practice Address - Street 2:SUITE 4045 PEACHTREE NEUROLOGICAL CLINIC, P.C.
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309
Practice Address - Country:US
Practice Address - Phone:404-351-2270
Practice Address - Fax:404-352-1969
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0431192084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00781063DMedicaid
GA13BDCWK01Medicare UPIN
GAG67300Medicare UPIN
GA13BDDRTMedicare ID - Type UnspecifiedMEDICARE