Active NPI
Russell Prentice Puckett, MD
- Emergency Medicine Physician
- Marietta, GA
National Provider Identifier
1225723505
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 114115
- Practice address
- 677 Church St NE
Marietta, GA 30060-1101 - Phone
- (770) 793-5000
- NPI assigned
- Apr 11, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 114115 | GA | Primary |
Addresses
Primary practice location
677 Church St NE
Marietta, GA 30060-1101
Mailing address
1422 N Enota Ave NW
Gainesville, GA 30501-2271
Phone (770) 778-8124
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230703002195 | GA | Order and Referring Only - Emergency Medicine | 4587023908 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1681171200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1784505600000",
"number": "1225723505",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1422 N ENOTA AVE NW",
"city": "GAINESVILLE",
"state": "GA",
"postal_code": "305012271",
"telephone_number": "770-778-8124"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "677 CHURCH ST NE",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300601101",
"telephone_number": "770-793-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUCKETT",
"first_name": "RUSSELL",
"middle_name": "PRENTICE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-04-11",
"last_updated": "2026-07-20",
"certification_date": "2026-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "GA",
"license": "114115",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.