Slack, Philip T.

Slack, Philip T. is an individual health care provider with primary practice located at 1315 Jesse Jewell Pkwy Ne Ste 300 , Gainesville GA 30501-3822. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Anesthesiology, Allopathic & Osteopathic Physicians / Pain Medicine. Allopathic & Osteopathic Physicians / Pain Medicine is his primary health care specialty. Slack, Philip T. can be contacted via phone (770) 219-6520.

Contact Information

Primary practice address
1315 Jesse Jewell Pkwy Ne Ste 300 Gainesville GA 30501-3822
Phone: (770) 219-6520
Fax: (770) 219-1016
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X 035523 Georgia
Allopathic & Osteopathic Physicians / Pain Medicine 207LP2900X 035523 Georgia

Profile Details

NPI number 1639113095
LBN Legal business name Slack, Philip T.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 16th, 2006
Last updated Oct 6th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1639113095 NPPES
Georgia MEDICAID 000552824C

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