Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 042716 | GA |
NPI | 1003971276 |
---|---|
Provider Name | Frank Gerard Russo-Alesi |
First Address | Rome, GA 30165-1369 |
Second Address | Rome, GA 30165-1625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 29/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000720013A | (05) | GA |
G05979 | (02) |