Provider Demographics
NPI:1164798179
Name:SLATER, CAROLYN (EDD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:SLATER
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 LAQUANDA CT SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-7890
Mailing Address - Country:US
Mailing Address - Phone:404-829-1610
Mailing Address - Fax:404-829-1610
Practice Address - Street 1:2525 LAQUANDA CT SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-7890
Practice Address - Country:US
Practice Address - Phone:404-829-1610
Practice Address - Fax:404-829-1610
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-25
Last Update Date:2012-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-R-0720372600000X
GA06-R-0720374U00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker