Provider Demographics
NPI:1043221070
Name:SLAUGHTER, TRACI (FNP/C)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:SLAUGHTER
Suffix:
Gender:F
Credentials:FNP/C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 CHESTNUT OAK LN
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-8964
Mailing Address - Country:US
Mailing Address - Phone:770-883-3771
Mailing Address - Fax:
Practice Address - Street 1:378 PERIMETER RD
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534
Practice Address - Country:US
Practice Address - Phone:678-389-6509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN107276363LF0000X, 363LF0000X
NC257643363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003143259AMedicaid
GA2025I09543Medicare PIN