Provider Demographics
NPI:1477207694
Name:SLADE, DARAUS AMARIA (NP)
Entity type:Individual
Prefix:
First Name:DARAUS
Middle Name:AMARIA
Last Name:SLADE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2174 N DRUID HILLS RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3102
Mailing Address - Country:US
Mailing Address - Phone:404-785-5437
Mailing Address - Fax:404-785-9111
Practice Address - Street 1:2174 N DRUID HILLS RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-3102
Practice Address - Country:US
Practice Address - Phone:404-785-5437
Practice Address - Fax:404-785-9111
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN275329363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty