Active NPI
Teki Mashawn Russell, OTR/L
- Contractor
- Senoia, GA
National Provider Identifier
1992196364
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- OT002684
- Practice address
- 444 Chestlehurst Rd
Senoia, GA 30276-2505 - Phone
- (770) 599-4500
- Fax
- (770) 599-4500
- NPI assigned
- Feb 6, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Contractor | 171W00000X | OT002684 | GA | Primary |
Addresses
Primary practice location
444 Chestlehurst Rd
Senoia, GA 30276-2505
Mailing address
20 Elizabeth Rd
Senoia, GA 30276-2524
Phone (770) 599-4500
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT002684 | GA | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1423180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1465430400000",
"number": "1992196364",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 ELIZABETH RD",
"city": "SENOIA",
"state": "GA",
"postal_code": "302762524",
"telephone_number": "770-599-4500",
"fax_number": "770-599-4500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "444 CHESTLEHURST RD",
"city": "SENOIA",
"state": "GA",
"postal_code": "302762505",
"telephone_number": "770-599-4500",
"fax_number": "770-599-4500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "TEKI",
"middle_name": "MASHAWN",
"name_prefix": "Miss",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-02-06",
"last_updated": "2016-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "GA",
"license": "OT002684",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Senoia, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.