Healthcare Provider Details

I. General information

NPI: 1447434907
Provider Name (Legal Business Name): MARZENA ELZBIETA SLATER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4555 N SHALLOWFORD RD STE 100
ATLANTA GA
30338-6407
US

IV. Provider business mailing address

11 DUNWOODY PARK STE 150
DUNWOODY GA
30338-7401
US

V. Phone/Fax

Practice location:
  • Phone: 404-727-8868
  • Fax:
Mailing address:
  • Phone: 404-778-6920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number002224
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: