Slade, Crystal O

Slade, Crystal O is an individual health care provider with primary practice located at 1279 Highway 54 W Suite 220, Fayetteville GA 30214-4552. She recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as her primary health care specialty. Slade, Crystal O can be contacted via phone (770) 991-2200.

Contact Information

Primary practice address
1279 Highway 54 W Suite 220 Fayetteville GA 30214-4552
Phone: (770) 991-2200
Fax: (770) 991-1341
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 053881 Georgia

Profile Details

NPI number 1154332542
LBN Legal business name Slade, Crystal O
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 10th, 2006
Last updated Oct 22nd, 2011 - about 14 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 1154332542 NPPES
Georgia MEDICAID 671094050A

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