Provider Demographics
NPI:1285079186
Name:KIRKS, RUSSELL CONNELLY (MD)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:CONNELLY
Last Name:KIRKS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:594 S COLUMBIA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-9095
Mailing Address - Country:US
Mailing Address - Phone:912-826-4057
Mailing Address - Fax:912-826-2853
Practice Address - Street 1:594 S COLUMBIA AVE STE 100
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-9095
Practice Address - Country:US
Practice Address - Phone:912-826-4057
Practice Address - Fax:912-826-2853
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2024-04-03
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Provider Licenses
StateLicense IDTaxonomies
GA79298208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery