Bryan S Russell, DPM FACFAS

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

POD001261 Issued in GA

Practice address

55 Whitcher St
Ste. 450
Marietta, GA 30060

Phone

(770) 590-4188

Fax

(770) 590-4189

NPI assigned

Mar 14, 2006

Last updated

Oct 30, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: brussell96242@directwellstar.org

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604016000000",
    "number": "1700854825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "559 VINCENT ST",
            "address_2": "ATTN: 21 MDOS/SGOF - ORTHO",
            "city": "PETERSON AFB",
            "state": "CO",
            "postal_code": "809141541",
            "telephone_number": "719-526-2273",
            "fax_number": "877-813-1756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 WHITCHER ST",
            "address_2": "STE. 450",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "30060",
            "telephone_number": "770-590-4188",
            "fax_number": "770-590-4189"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "559 Vincent St",
            "address_2": "ATTN: 21 MDOS/SGOF - Ortho",
            "address_purpose": "LOCATION",
            "city": "Peterson AFB",
            "state": "CO",
            "postal_code": "809141541",
            "country_code": "US",
            "telephone_number": "719-526-2273",
            "fax_number": "877-813-1756",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "BRYAN",
        "middle_name": "S",
        "credential": "DPM FACFAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-14",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "GA",
            "license": "POD001261",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "GA",
            "license": "POD001261",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0003150721C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Keonna Rushin
• Michael Ruskin
• Russell Nutrition LLC
• Barbara T Russell, LPC
• Brittane Russell, ED.S, BCBA
• Caitlin Russell, MS, RD, LD
• Cynthia Russell, LCSW
• Gregg E Russell, OD
• Irving Russell, D.C.
• Lonnie Nicholas Russell, MD

• Foot & Ankle Surgery Podiatrist in Marietta, GA
• Providers in Marietta, GA by specialty
• Foot & Ankle Surgery Podiatrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.