Provider Demographics
NPI:1740747153
Name:CARRINGTON MEDICAL SPA LLC
Entity Type:Organization
Organization Name:CARRINGTON MEDICAL SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LILIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SLUTSKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-508-5723
Mailing Address - Street 1:8178 GADSDEN HWY STE 112
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-5267
Mailing Address - Country:US
Mailing Address - Phone:205-508-5723
Mailing Address - Fax:205-508-5724
Practice Address - Street 1:8178 GADSDEN HWY STE 112
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-5267
Practice Address - Country:US
Practice Address - Phone:205-508-5723
Practice Address - Fax:205-508-5724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-22
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080B0002XAllopathic & Osteopathic PhysiciansPediatricsObesity MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL34099OtherPENDING