DR. TIMOTHY GLENN RUSSELL (NPI# 1073937132) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073937132 |
| Entity Type | Individual |
| Full Name | DR. TIMOTHY GLENN RUSSELL |
| Credential | M.D. |
| Practice Address |
6600 Van Aalst Blvd Department of Radiology Fort Benning GA 31905-2102 |
| Mailing Address |
6600 Van Aalst Blvd Credentials Office Fort Benning GA 31905 |
| Practice Telephone | 7624082013 |
| Mailing Telephone | 7624080454 |
| Mailing Fax Number | 7624080405 |
| Enumeration Date | 2014-02-10 |
| Last Update Date | 2020-09-09 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
28944 | NE | Allopathic & Osteopathic Physicians |
| N | 208D00000X | General Practice | 28944 | NE | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306048491 | Timothy Wade Russell | Chiropractor | 325 E. Hawkeye Ave., Remsen, IA 51050-0086 | 2007-06-01 |
| 1770565087 | Timothy Paul Russell | Family Medicine | Unit 45011 Bldg 704, Attn: Mcja-qm, Usa Meddac-japan, Apo, AP 96338-5011 | 2005-11-14 |
| 1528471083 | Timothy Russell | Radiologic Technologist | 6431 Wade Springs Rd, Murfreesboro, TN 37130-8719 | 2014-06-03 |
| 1013264530 | Timothy A Russell | Physical Therapist | 11482 Okeechobee Blvd, Suite 2, Royal Palm Beach, FL 33411-8735 | 2012-08-15 |
| 1417270786 | Timothy Gage Russell | Physician Assistant | 850 E Harvard Ave Ste 265, Denver, CO 80210-5075 | 2010-03-01 |
| 1487863403 | Timothy Lynn Russell | Massage Therapist | 1100 E 3rd St, Suite G-100, Chattanooga, TN 37403-2201 | 2007-05-22 |
| 1831108463 | Timothy Elmer Russell IIi | Dentist | 2616 Sherwood Hall Lane, Suite 405, Alexandria, VA 22306 | 2006-08-05 |
| 1962418103 | Timothy J. Russell | Emergency Medicine | 1200 Maple Rd, Silver Cross, Joliet, IL 60432-1439 | 2006-07-31 |
| Street Address |
6600 VAN AALST BLVD DEPARTMENT OF RADIOLOGY |
| City | FORT BENNING |
| State | GA |
| Zip Code | 31905-2102 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184608218 | Fletcher Maurice Boulware Jr. | Anesthesiology | 6600 Van Aalst Blvd, Anesthesia Suite 2nd Floor, Fort Benning, GA 31905 | 2005-12-01 |
| 1700486669 | Krystal Smith Dabon | Nurse Practitioner | 6600 Van Aalst Blvd, Fort Benning, GA 31905-2102 | 2020-10-29 |
| 1508466731 | Nichelle Pascoe | Student in an Organized Health Care Education/Training Program | 6600 Van Aalst Blvd, Fort Benning, GA 31905-2102 | 2020-10-27 |
| 1598372518 | Delli Dorne | Nurse Practitioner | 6600 Van Aalst Blvd, Fort Benning, GA 31905-2102 | 2020-09-24 |
| 1205442944 | Vincent Krause | Nurse Practitioner | 6600 Van Aalst Blvd, Fort Benning, GA 31905-2102 | 2020-09-18 |
| 1578175824 | Shawn Nguyen | Optometrist | 6600 Van Aalst Blvd, Fort Benning, GA 31905-2102 | 2020-08-18 |
| 1720606791 | Aylin Seyalioglu | Physical Therapist | 6600 Van Aalst Blvd, Fort Benning, GA 31905-2102 | 2020-07-07 |
| 1578187431 | Travis Ian Hallquist | Registered Nurse | 6600 Van Aalst Blvd, Fort Benning, GA 31905-2102 | 2020-06-05 |
| 1770121899 | Rachel Elizabeth Cobb | Audiologist-Hearing Aid Fitter | 6600 Van Aalst Blvd, Fort Benning, GA 31905-2102 | 2019-12-19 |
| 1518516657 | Emily L Derosa | Physician Assistant | 6600 Van Aalst Blvd, Fort Benning, GA 31905-2102 | 2019-09-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134741366 | Micah Elizabeth Lajoie | Specialist/Technologist | 7148 2nd Cavalry Street, Ft. Benning, GA 31905 | 2020-05-11 |
| 1598301384 | Tiffany Nicole Wolfe | Physical Therapist | 7446 Sightseeing Road, Bldg 2515, Ft Benning, GA 31905 | 2019-11-27 |
| 1790261022 | Kyle Joseph Burkardt | Dentist | Love Dental Clinic, 7101 Hoff St, Bldg 9240, Apo, AA 31905 | 2018-07-19 |
| 1821514449 | Rebekah Schott | Dentist | 7101 Hoff St., Fort Benning, GA 31905 | 2017-08-15 |
| 1043757677 | Karen Tolliver | Dental Hygienist | 7770 Sightseeing Rd, Bldg 2828, Fort Benning, GA 31905 | 2017-01-20 |
| 1356897953 | Katelyn Dolezal | Student in an Organized Health Care Education/Training Program | 6600 Van Aalst Blvd, Bldg 9250, Fort Benning, GA 31905 | 2016-09-01 |
| 1043663636 | Vicky J. Nehl | Dental Hygienist | 11th Abn Div Rd, Bldg 3255, Fort Benning, GA 31905 | 2016-07-19 |
| 1376992719 | Xenia Key | Dental Assistant | 7770 Sightseeing Road, Bernheim Dental Clinic, Fort Benning, GA 31905 | 2016-06-07 |
| 1588013189 | Barbara Parker | Dental Assistant | 2828 Sightseeing Rd, Fort Benning, GA 31905 | 2016-06-06 |
| 1568811255 | Tavonna Ashley | Dental Hygienist | 7107 Hoff Street, Apo, AA 31905 | 2016-06-03 |
| Find all providers in zip 31905 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649566829 | Lori Michele Freetage | Radiology | 6600 Van Aalst Blvd, Fort Benning, GA 31905 | 2011-06-25 |
| 1861786063 | Christopher Phillip Wagner | Radiology | 6600 Van Aalst Blvd, Martin Army Community Hospital, Fort Benning, GA 31905-0000 | 2011-06-06 |
| 1376753905 | Leland Taylor | Radiology | 7950 Martin Loop, Martin Army Community Hospital, Fort Benning, GA 31905 | 2007-05-23 |
| 1598853319 | Ildefonso G.d. Almonte | Radiology | 7950 Martin Loop, Fort Benning, GA 31905-5647 | 2006-10-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326650136 | Tbi Diagnostic Centers of Georgia | Radiology | 4294 Memorial Dr Ste D, Decatur, GA 30032-1226 | 2020-08-21 |
| 1912464702 | Vickie Consuella71 Bush | Radiology | 3701 Bermuda Run Dr, Valdosta, GA 31605-1059 | 2019-02-27 |
| 1932685096 | T2 Imaging | Radiology | 1376 Church Street, Suite 100, Decatur, GA 30030 | 2018-07-12 |
| 1578061636 | Subspecialty Imaging, LLC | Radiology | 1495 Hickory Flat Hwy Ste 150, Canton, GA 30115-4229 | 2018-01-24 |
| 1205354693 | Zenith Radiology LLC | Radiology | 1059 Windermere Xing, Cumming, GA 30041-6104 | 2017-09-06 |
| 1558886341 | Synergy Radiology, LLC | Radiology | 1501 Milstead Road, Suite 140, Conyers, GA 30012 | 2017-08-14 |
| 1932624723 | M & B Imaging, PC | Radiology | 1640 Jesse Jewell Pkwy Se Ste 2, Gainesville, GA 30501 | 2017-08-14 |
| 1902346422 | Allegiance Imaging and Radiology LLC | Radiology | 900 Thornton Rd, Ste A, Lithia Springs, GA 30122-2641 | 2017-03-02 |
| 1518406743 | Flexogenix Georgia PC | Radiology | 4600 Roswell Rd Unit E210, Sandy Springs, GA 30342-3197 | 2017-02-21 |
| 1649727215 | Metro Imaging Cumming, LLC | Radiology | 4150 Deputy Bill Cantrell Memorial Road, Cumming, GA 30040 | 2016-09-01 |
| Find all providers with the same taxonomy | ||||
| City | FORT BENNING |
| Zip Code | 31905 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.