Provider Demographics
NPI:1801852504
Name:SLAUGHTER, TERRY WAYNE JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:WAYNE
Last Name:SLAUGHTER
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4590 VANADIUM BND
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-8892
Mailing Address - Country:US
Mailing Address - Phone:678-200-8797
Mailing Address - Fax:
Practice Address - Street 1:4590 VANADIUM BND
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-8892
Practice Address - Country:US
Practice Address - Phone:678-200-8797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2010-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1101852367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000856721AMedicaid
AL051554927Medicaid
AL051523938OtherBLUE CROSS
AL051554927Medicare ID - Type Unspecified
43ZCBFQ56Medicare PIN
AL051523938OtherBLUE CROSS