Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kelly Russin, PA

Individual provider Physician Assistant · NPI 1780745554

Kelly Russin, PA is a Physician Assistant in Union City, Georgia. Qualified in 2003, 23 years ago. Practices with Southside Medical Care, a 2-clinician group and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
23
Licensed in
GA
In the registry since
2006
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

See every abbreviation used in this directory →

Practice location Address checks out

6325 Shannon Pkwy Ste D
Union City, GA 30291-1538
Phone: (770) 964-1400
Fax: (770) 306-1343
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 004096 (GA)

Record details

NPI number1780745554
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedDecember 13, 2006
Last updated in NPPESJuly 26, 2012

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2003 (23 years in practice)
Group practice Southside Medical Care — 2 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount