Provider Demographics
NPI:1336539295
Name:SLATER, AMY HARTT (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:HARTT
Last Name:SLATER
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:136 COTTSWOLD LN
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-7056
Mailing Address - Country:US
Mailing Address - Phone:843-425-1034
Mailing Address - Fax:
Practice Address - Street 1:1350 WALTON WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2612
Practice Address - Country:US
Practice Address - Phone:706-774-7855
Practice Address - Fax:706-364-0516
Is Sole Proprietor?:No
Enumeration Date:2015-01-30
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA08849363A00000X
NC0010-05564363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant