Individual
PHILIP T. SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1315 JESSE JEWELL PKWY NE STE 300, GAINESVILLE, GA 30501-3822
(770) 219-6520
(770) 219-1016
Mailing address
PO BOX 742616, ATLANTA, GA 30374-2616
(770) 219-8420
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
035523
GA
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
035523
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000552824C
—
GA
Enumeration date
06/16/2006
Last updated
10/06/2020
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