Active NPI
Natalie Russo, MD
- Family Medicine Physician
- Athens, GA
National Provider Identifier
1366620171
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 029772
- Practice address
- 55 Carlton St
Athens, GA 30602-1526 - Phone
- (706) 542-8621
- Fax
- (706) 583-0217
- NPI assigned
- Feb 4, 2008
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 029772 | GA | Primary |
Addresses
Primary practice location
55 Carlton St
Athens, GA 30602-1526
Mailing address
55 Carlton St
Athens, GA 30602-1526
Phone (706) 542-8621
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00355396C | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 029772 | GA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202083200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257206400000",
"number": "1366620171",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 CARLTON ST",
"city": "ATHENS",
"state": "GA",
"postal_code": "306021526",
"telephone_number": "706-542-8621",
"fax_number": "706-583-0217"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 CARLTON ST",
"city": "ATHENS",
"state": "GA",
"postal_code": "306021526",
"telephone_number": "706-542-8621",
"fax_number": "706-583-0217"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSO",
"first_name": "NATALIE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-02-04",
"last_updated": "2009-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "GA",
"license": "029772",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00355396C",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Athens, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.