Healthcare Provider Details

I. General information

NPI: 1609732189
Provider Name (Legal Business Name): JULISIA CHADE SLATER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MEDICAL PARK DR E
BIRMINGHAM AL
35235-3401
US

IV. Provider business mailing address

5488 WISTERIA TRCE
TRUSSVILLE AL
35173-6316
US

V. Phone/Fax

Practice location:
  • Phone: 205-838-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QD0401X
TaxonomyDiabetology Physician
License Number1-162350
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: