Jason Russell
Jason Russell is a Driver in Southaven, Mississippi. Licensed in Tennessee. Registered with an NPI since 2023.
- Licensed in
- TN
- In the registry since
- 2023
Practice location Address checks out
8331 Blue Ridge DrSouthaven, MS 38672-6589
Phone: (901) 857-5961
Show map & directions
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Driver (primary) | Taxonomy 172A00000X · Licence 086149826 (TN) |
|---|
Record details
| NPI number | 1225717325 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | No |
| NPI enumerated | July 14, 2023 |
| Last updated in NPPES | July 14, 2023 |
| Certification date | July 14, 2023 |
| Mailing address | 5425 Lake Village Dr, Memphis, TN 38125-4106 |
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Mr. Kenji Jermaine Wells
8331 Blue Ridge Dr, Southaven, MS 38672-6589 · (901) 857-5961