Basic Information
| Provider Information | |||||||||
| NPI: | 1396040945 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARNER | ||||||||
| FirstName: | RUSSELL | ||||||||
| MiddleName: | HINTON | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 108 CLINTON PKWY | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390564730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019262018 | ||||||||
| FaxNumber: | 6019249746 | ||||||||
| Practice Location | |||||||||
| Address1: | 108 CLINTON PKWY | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390564730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019262018 | ||||||||
| FaxNumber: | 6019249746 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2011 | ||||||||
| LastUpdateDate: | 12/03/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA3976 | MS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.