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General NPI Number Information
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NPI Number | 1245217983
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Entity Type | Individual
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Provider Name | RUSSELL LEE SLIKER M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/23/2005
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Last Update Date | 05/31/2011
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Provider Practice Location Address
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Address Line | 1000 TOWNE CENTER BLVD STE 701
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City | POOLER
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State | GA
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Zip | 31322-4063
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Country | US
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Telephone | 912-748-2280
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Fax | 912-748-4988
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Provider Business Mailing Address
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Address Line | PO BOX 15849
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City | SAVANNAH
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State | GA
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Zip | 31416-2549
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Country | US
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Telephone | 912-748-2280
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Fax | 912-748-4988
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 046250
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License Number State | GA
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