NPIMap

Individual provider Active NPI

Lonnie Nicholas Russell, MD

  • Family Medicine Physician
  • Marietta, GA
National Provider Identifier
1053873612
Registry record updated Sep 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
88192 Issued in GA
Practice address
660 Cherokee St NE Ste 100
Marietta, GA 30060-8930
Phone
(678) 797-8201
NPI assigned
Apr 3, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 88192 GA Primary

Addresses

Primary practice location

660 Cherokee St NE Ste 100
Marietta, GA 30060-8930

Mailing address

450 14TH St NW
Atlanta, GA 30318-7963
Phone (843) 291-2836

Other practice location 1

450 14th St NW
Atlanta, GA 30318-7963
Phone (404) 480-9797

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210812002014 GA Practitioner - Family Practice 3870828692 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of South Carolina School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Piedmont Professional Services LLCGroup PAC ID 8921176231, 171 clinicians
Piedmont Medical Care CorporationGroup PAC ID 6002802220, 368 clinicians

Practice addresses (Care Compare)

1855 Hudson Bridge Rd
Stockbridge, GA 30281-5000
Phone (678) 732-1529

660 Cherokee St NE
Suite 100
Marietta, GA 30060-8930
Phone (678) 797-8210

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.51 of 100Reported as apm
Quality
80.61
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
91.62 of 100Reported as apm
Quality
83.25
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Peachtree Immediate Care FP, LLC Family Medicine CurrentSince May 8, 2021 Accepting new patients
Piedmont Medical Care Corporation Family Medicine CurrentSince Oct 9, 2023 Accepting new patients
Piedmont Providers LLC Past Accepting new patients

Locations

450 14th St NW
Atlanta, GA 30318
Phone (404) 480-9797

105 Collier Rd NW
Ste 5020
Atlanta, GA 30309
Phone (404) 350-3860

590 Lanier Ave W
Fayetteville, GA 30214

1275 Highway 54 W
Ste 201
Fayetteville, GA 30214
Phone (770) 461-3776

3827 Jimmy Lee Smith Pkwy
Hiram, GA 30141
Phone (770) 222-8900

660 Cherokee St NE
Ste 100
Marietta, GA 30060
Phone (678) 797-8201

4327 Hugh Howell Rd
Tucker, GA 30084
Phone (404) 292-8335

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695772800000",
    "number": "1053873612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 14TH ST NW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303187963",
            "telephone_number": "843-291-2836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "660 CHEROKEE ST NE STE 100",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300608930",
            "telephone_number": "678-797-8201"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "450 14th St NW",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303187963",
            "country_code": "US",
            "telephone_number": "404-480-9797",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "LONNIE",
        "middle_name": "NICHOLAS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-03",
        "last_updated": "2023-09-27",
        "certification_date": "2023-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "88192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.