Provider Demographics
NPI:1225033913
Name:SLATER, MONTE D (MD)
Entity Type:Individual
Prefix:
First Name:MONTE
Middle Name:D
Last Name:SLATER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1297
Mailing Address - Street 2:
Mailing Address - City:HAWKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31036-7297
Mailing Address - Country:US
Mailing Address - Phone:478-783-9340
Mailing Address - Fax:478-783-3961
Practice Address - Street 1:222 PERRY HWY
Practice Address - Street 2:
Practice Address - City:HAWKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31036-6748
Practice Address - Country:US
Practice Address - Phone:478-783-9340
Practice Address - Fax:478-783-3961
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2015-04-22
Deactivation Date:2005-06-27
Deactivation Code:
Reactivation Date:2005-07-01
Provider Licenses
StateLicense IDTaxonomies
GA045968207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000797684AMedicaid
GA1225033913Medicare UPIN
GA000797684AMedicaid