Provider Demographics
NPI:1730747817
Name:RUSSELL, TIERAH
Entity type:Individual
Prefix:
First Name:TIERAH
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIERAH
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2911 LEISURE WOODS LN
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-3430
Mailing Address - Country:US
Mailing Address - Phone:404-834-1735
Mailing Address - Fax:
Practice Address - Street 1:2911 LEISURE WOODS LN
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-3430
Practice Address - Country:US
Practice Address - Phone:404-834-1735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No171WH0202XOther Service ProvidersContractorHome Modifications
No172A00000XOther Service ProvidersDriver
No174H00000XOther Service ProvidersHealth Educator
No175L00000XOther Service ProvidersHomeopath
No372500000XNursing Service Related ProvidersChore Provider
No376G00000XNursing Service Related ProvidersNursing Home Administrator
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide