Provider Demographics
NPI:1386784007
Name:CHRIS B. RUSSELL M.D., P.C.
Entity type:Organization
Organization Name:CHRIS B. RUSSELL M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:B
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-533-0856
Mailing Address - Street 1:204 LOWE AVE SE
Mailing Address - Street 2:SUITE 6, BLDG 2
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4262
Mailing Address - Country:US
Mailing Address - Phone:256-533-0856
Mailing Address - Fax:256-533-7981
Practice Address - Street 1:204 LOWE AVE SE
Practice Address - Street 2:SUITE 6, BLDG 2
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4262
Practice Address - Country:US
Practice Address - Phone:256-533-0856
Practice Address - Fax:256-533-7981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15044261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care