Gregory Russell, O.D

NPI 1033144225 · on the registry since 2006 · sole proprietor

Practice

Address: 102 Professional Park Pvt Dr
Kingsport, TN 37663
Phone: (423) 245-2222
Fax: (423) 245-4822
Organisation at this address: Forever Young Medical Aesthetics And Weight Loss Llc
Inferred from a shared address, not stated in the registry.

Registry record

Primary taxonomy: 152W00000X
152W00000X
Licence states on file: TN
From the registry's licence fields, which are often incomplete.
Sex: Male
Record last updated: 2007-07-09

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Tennessee