Provider Demographics
NPI:1124126099
Name:RUSSELL A FRIEDMAN PC
Entity type:Organization
Organization Name:RUSSELL A FRIEDMAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-641-9797
Mailing Address - Street 1:8800 ROSWELL RD
Mailing Address - Street 2:SUITE A235
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-1826
Mailing Address - Country:US
Mailing Address - Phone:770-641-9797
Mailing Address - Fax:770-641-9771
Practice Address - Street 1:8800 ROSWELL RD
Practice Address - Street 2:SUITE A235
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30350-1826
Practice Address - Country:US
Practice Address - Phone:770-641-9797
Practice Address - Fax:770-641-9771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
GACHIR005683111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5597950001OtherDMERC SUPPLIER
GA35ZCDQJMedicare ID - Type Unspecified