Basic Information
| Provider Information | |||||||||
| NPI: | 1003800665 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GORE | ||||||||
| FirstName: | RUSSELL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2020 PEACHTREE RD NW | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303091426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043507323 | ||||||||
| FaxNumber: | 4043507694 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 WOODRUFF CIR STE 6000 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303220001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047275004 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2005 | ||||||||
| LastUpdateDate: | 01/31/2018 | ||||||||
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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 | 2083A0100X | 052072 | GA | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Aerospace Medicine | 2084N0400X | 52072 | GA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.