Provider Demographics
NPI:1437107364
Name:SLATON, FELICIA R (PA)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:R
Last Name:SLATON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 PARKWAY N
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265
Mailing Address - Country:US
Mailing Address - Phone:770-400-6588
Mailing Address - Fax:770-400-6900
Practice Address - Street 1:600 PARKWAY N
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-8000
Practice Address - Country:US
Practice Address - Phone:770-400-6588
Practice Address - Fax:770-400-6900
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004488363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ50704Medicare UPIN
GA97WCGVQMedicare ID - Type Unspecified