PHILIP T. SLACK (NPI# 1639113095) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639113095 |
| Entity Type | Individual |
| Full Name | PHILIP T. SLACK |
| Credential | MD |
| Practice Address |
1315 Jesse Jewell Pkwy Ne Ste 300 Gainesville GA 30501-3822 |
| Mailing Address |
Po Box 742616 Atlanta GA 30374-2616 |
| Practice Telephone | 7702196520 |
| Practice Fax Number | 7702191016 |
| Mailing Telephone | 7702198420 |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2020-10-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207L00000X | Anesthesiology | 035523 | GA | Allopathic & Osteopathic Physicians |
| Y | 207LP2900X |
Anesthesiology Specialization: Pain Medicine |
035523 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 000552824C | 05 |
| Street Address |
1315 JESSE JEWELL PKWY NE STE 300 |
| City | GAINESVILLE |
| State | GA |
| Zip Code | 30501-3822 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295729945 | Ann Marie Byers | Nurse Practitioner | 1315 Jesse Jewell Pkwy Ne Ste 300, Gainesville, GA 30501-3822 | 2005-09-08 |
| 1477104834 | Rachel Lynn Metz | Physician Assistant | 1315 Jesse Jewell Pkwy Ne Ste 300, Gainesville, GA 30501-3822 | 2019-09-26 |
| 1194176446 | Nhi-kieu Nguyen | Family Medicine | 1315 Jesse Jewell Pkwy Ne Ste 300, Gainesville, GA 30501 | 2016-06-28 |
| 1699132605 | Stacy Marie Eaton | Nurse Practitioner | 1315 Jesse Jewell Pkwy Ne Ste 300, Gainesville, GA 30501-3822 | 2016-01-21 |
| 1396088027 | Ava Ferdinand | Psychiatry & Neurology | 1315 Jesse Jewell Pkwy Ne Ste 300, Gainesville, GA 30501-3822 | 2013-04-01 |
| 1639422983 | Natalya Kovalenko | Physician Assistant | 1315 Jesse Jewell Pkwy Ne Ste 300, Gainesville, GA 30501-3822 | 2012-10-24 |
| 1942567060 | James Nathaniel Starr | Psychiatry & Neurology | 1315 Jesse Jewell Pkwy Ne Ste 300, Gainesville, GA 30501-3822 | 2012-04-13 |
| 1013292382 | Laura J Banner | Nurse Practitioner | 1315 Jesse Jewell Pkwy Ne Ste 300, Gainesville, GA 30501-3822 | 2011-10-18 |
| 1023176369 | James Patrick Mullin | Clinical Neuropsychologist | 1315 Jesse Jewell Pkwy Ne Ste 300, Gainesville, GA 30501 | 2006-12-05 |
| 1639253818 | Devin Paige Vicknair | Counselor | 1315 Jesse Jewell Pkwy Ne Ste 300, Gainesville, GA 30501 | 2006-10-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437782851 | Madison Raye Huth | Physician Assistant | 743 Spring Street Se, Gainesville, GA 30501 | 2020-02-13 |
| 1205487659 | Grace M Walker Brown | Nurse Practitioner | 592 Medical Park Dr., Suite A, Gainesville, GA 30501 | 2019-09-26 |
| 1174086987 | Nayab Ahmed | Student in an Organized Health Care Education/Training Program | 743 Spring Street, Suite 710, Gainesville, GA 30501 | 2019-04-09 |
| 1154881118 | Ryan D Berry | Student in an Organized Health Care Education/Training Program | 734 Spring St Se Ste 710, Gainesville, GA 30501 | 2019-03-24 |
| 1609336304 | Harper E Niver | Student in an Organized Health Care Education/Training Program | 743 Spring St., Suite 710, Gainesville, GA 30501 | 2019-03-20 |
| 1508336173 | Bradee Burrell Aderholt | Nurse Practitioner | 663 Lanier Park Drive, Gainesville, GA 30501 | 2018-11-27 |
| 1578068359 | Soammy Liz Matias | Chiropractor | 961 Green Street, Gainesville, GA 30501 | 2018-03-26 |
| 1811496896 | Matthew Brown | Speech-Language Pathologist | 500 Spring St. Se Suite 101, Gainesville, GA 30501 | 2018-02-06 |
| 1346769825 | Dr. Skeete & Associates of North Georgia, P.C. | Optometrist | 150 Pearl Nix Parkway, Suite D3a, Gainesville, GA 30501 | 2017-09-15 |
| 1932624723 | M & B Imaging, PC | Radiology | 1640 Jesse Jewell Pkwy Se Ste 2, Gainesville, GA 30501 | 2017-08-14 |
| Find all providers in zip 30501 | ||||
| Taxonomy Code | 207LP2900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Anesthesiology |
| Specialization | Pain Medicine |
| An anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic and/or cancer pain in both hospital and ambulatory settings. Patient care needs are also coordinated with other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Anesthesiology, 2007. http://www.theaba.org/; American Osteopathic Board of Anesthesiology, 2007, http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Anesthesiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Anesthesiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649615584 | Nj Medical Services PC | Anesthesiology | 1016 Thompson Bridge Rd, Gainesville, GA 30501-1704 | 2013-05-06 |
| 1770510125 | Naglaa Zidan Elsayed Abdel-al | Anesthesiology | 4001 W Newberry Rd Ste E3, Gainesville, FL 32607-2389 | 2006-06-28 |
| 1730164161 | Robert George Valentine Jr. | Anesthesiology | 7550 W University Ave, Ste A, Gainesville, FL 32607-7607 | 2005-12-08 |
| 1194168641 | Juan Camilo Mora Herrera | Anesthesiology | 1600 Sw Archer Rd, Gainesville, FL 32610-0254 | 2013-04-15 |
| 1841564630 | Scott W Campbell, Md Pa | Anesthesiology | 1900 Hospital Blvd, Gainesville, TX 76240-2002 | 2012-02-27 |
| 1245407279 | Sanjeev Kumar | Anesthesiology | 1600 Sw Archer Rd, Box 100254, Gainesville, FL 32610-0254 | 2008-05-08 |
| 1215013081 | Gainesville Outpatient Anesthesia Pa | Anesthesiology | 4600 Newberry Road, Gainesville, FL 32607-2247 | 2006-10-27 |
| 1255369732 | Stephanie J Smith | Anesthesiology | 1250 Jesse Jewell Pkwy Se Ste 200, Gainesville, GA 30501-3865 | 2006-06-30 |
| 1467480103 | North Florida Pain Specialists Pa | Anesthesiology | 1130 Nw 64th Ter, Suite C, Gainesville, FL 32605-4219 | 2006-06-29 |
| 1740263011 | John Lee Givogre | Anesthesiology | 2335 Limestone Overlook, Gainesville, GA 30501-7443 | 2005-11-21 |
| Find all providers in GAINESVILLE | ||||
| City | GAINESVILLE |
| Zip Code | 30501 |
Please comment or provide details below to improve the information on PHILIP T. SLACK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.