Healthcare Provider Details

I. General information

NPI: 1760592513
Provider Name (Legal Business Name): RANDALL J. SLOVIS, M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 PEACHFORD RD
ATLANTA GA
30338-6534
US

IV. Provider business mailing address

45 ASHEWORTH CT NW
ATLANTA GA
30327-1532
US

V. Phone/Fax

Practice location:
  • Phone: 770-445-3200
  • Fax: 770-458-1594
Mailing address:
  • Phone: 770-458-1594
  • Fax: 770-458-1596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number025392
License Number StateGA

VIII. Authorized Official

Name: DR. RANDALL JAY SLOVIS
Title or Position: OWNER
Credential: M.D.
Phone: 770-458-1594