Provider Demographics
NPI:1851833792
Name:SLAYDEN, MALISSA
Entity Type:Individual
Prefix:
First Name:MALISSA
Middle Name:
Last Name:SLAYDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PERIMETER PARK DR
Mailing Address - Street 2:SUITE 224
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1321
Mailing Address - Country:US
Mailing Address - Phone:678-460-6442
Mailing Address - Fax:
Practice Address - Street 1:10 PERIMETER PARK DR
Practice Address - Street 2:SUITE 224
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-1321
Practice Address - Country:US
Practice Address - Phone:678-460-6442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator