Provider Demographics
NPI:1154116366
Name:RUSSELL, SHARANDA L
Entity type:Individual
Prefix:
First Name:SHARANDA
Middle Name:L
Last Name:RUSSELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 451331
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31145-9331
Mailing Address - Country:US
Mailing Address - Phone:470-640-4605
Mailing Address - Fax:
Practice Address - Street 1:5535 DOWNS WAY
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-7853
Practice Address - Country:US
Practice Address - Phone:470-640-4605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker