Healthcare Provider Details

I. General information

NPI: 1720531023
Provider Name (Legal Business Name): RYAN M SLATTERY D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 09/24/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 EAST HOSPITAL ROAD TRANSITIONAL YEAR, DDEAMC
FORT GORDON GA
30905-5650
US

IV. Provider business mailing address

300 EAST HOSPITAL ROAD
FORT GORDON GA
30905-5650
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-1648
  • Fax: 706-787-1745
Mailing address:
  • Phone: 706-787-1648
  • Fax: 706-787-1745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2485
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: