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1194315572
KASSIE RUSSOM
CHARLESTON, SC
NPI
1194315572
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: SC 3982)
Additional Taxonomies
363A00000X Physician Assistant
Enumeration Date
2021-01-20
Last Update Date
2022-07-11
Business Address
KASSIE RUSSOM PA-C
316 CALHOUN ST
CHARLESTON, SC 29401-1113
Phone number: 843-724-2450
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Mailing Address
KASSIE RUSSOM PA-C
PO BOX 751649
CHARLOTTE, NC 28275-1649
Phone number: 843-789-1620
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