Healthcare Provider Details

I. General information

NPI: 1972929172
Provider Name (Legal Business Name): GENEVIEVE SLAUGHTER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GENEVIEVE FORGES NP-C

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 PLEASANT HILL RD STE 100
DULUTH GA
30096-8030
US

IV. Provider business mailing address

856 J CLYDE MORRIS BLVD SUITE A
NEWPORT NEWS VA
23601-1318
US

V. Phone/Fax

Practice location:
  • Phone: 678-312-7800
  • Fax: 678-312-7818
Mailing address:
  • Phone: 757-594-4006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024171578
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN257222
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: