| NPI | 1124488291 |
|---|---|
| Doing Business As | LAKE RUSSELL SPECIALTY HEALTHCARE SERVICES |
| Entity Type | Organization |
| Authorized Contact | BRANDON CLARY CEO 706-213-2535 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology |
| Additional Taxonomies | 207Y00000X Otolaryngology |
| 208600000X Surgery | |
| Enumeration Date | 2016-03-02 |
| Last Update Date | 2016-03-24 |