Healthcare Provider Details

I. General information

NPI: 1245217983
Provider Name (Legal Business Name): RUSSELL LEE SLIKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 05/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 TOWNE CENTER BLVD STE 701
POOLER GA
31322-4063
US

IV. Provider business mailing address

PO BOX 15849
SAVANNAH GA
31416-2549
US

V. Phone/Fax

Practice location:
  • Phone: 912-748-2280
  • Fax: 912-748-4988
Mailing address:
  • Phone: 912-748-2280
  • Fax: 912-748-4988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number046250
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: