Provider Demographics
NPI:1427474766
Name:CLINDING, RUSSELL
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:
Last Name:CLINDING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RUSSELL
Other - Middle Name:
Other - Last Name:CLINDING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OT
Mailing Address - Street 1:5036 SNAPFINGER WOODS DR STE 217
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-4047
Mailing Address - Country:US
Mailing Address - Phone:678-418-0066
Mailing Address - Fax:678-418-0122
Practice Address - Street 1:5036 SNAPFINGER WOODS DR STE 217
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-4047
Practice Address - Country:US
Practice Address - Phone:678-418-0066
Practice Address - Fax:678-418-0122
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003891174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist