Zachary Russell, ATC, LAT, CSCS, OTC

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

License

AT003715 Issued in GA

Practice address

1305 Jennings Mill Road
Building 300, Suite 110
Watkinsville, GA 30677

Phone

(706) 613-5880

Fax

(706) 613-5880

NPI assigned

Oct 26, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• Piedmont Athens Specialty Care LLC

  • Cardiovascular Disease Physician
  • Athens, GA
  • NPI 1184130627
  NPD

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

{
    "created_epoch": "1445817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569542400000",
    "number": "1750753182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5883 N NEVADA AVE",
            "address_2": "324",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809183507",
            "telephone_number": "678-481-6519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 JENNINGS MILL ROAD",
            "address_2": "BUILDING 300, SUITE 110",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "30677",
            "telephone_number": "706-613-5880",
            "fax_number": "706-613-5880"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2200 Bonforte Blvd",
            "address_purpose": "LOCATION",
            "city": "Pueblo",
            "state": "CO",
            "postal_code": "810014901",
            "country_code": "US",
            "telephone_number": "678-481-6519",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "ZACHARY",
        "credential": "ATC, LAT, CSCS, OTC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-10-26",
        "last_updated": "2019-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CO",
            "license": "0001416",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "GA",
            "license": "AT003715",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Benjamin Rosen, M.S.P.A.S., PA-C
• Wayne M Rosen, MD
• Erin Reeves Rosene, MS
• Anaiah Rucker, RBT
• Martha E Rumsey, LCSW
• Audrey Russo, FNP-C
• Minou Rysiew, L.C.S.W.
• Pimchanok Saardphothong, RBT
• Aliya Safwan, MD
• David Mathis Sailors, MD

• Sports Medicine (Orthopaedic Surgery) Physician in Watkinsville, GA
• Providers in Watkinsville, GA by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2019; 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.