Provider Demographics
NPI:1407824378
Name:SLOTIN, DAVID MARCUS (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MARCUS
Last Name:SLOTIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 BUSBEE DR NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-5677
Mailing Address - Country:US
Mailing Address - Phone:770-422-0064
Mailing Address - Fax:
Practice Address - Street 1:3525 BUSBEE DR NW
Practice Address - Street 2:SUITE 100
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5677
Practice Address - Country:US
Practice Address - Phone:770-422-0064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001523363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical