Provider Demographics
NPI:1750413779
Name:SLAY, VERSIE LEE (MD)
Entity type:Individual
Prefix:DR
First Name:VERSIE
Middle Name:LEE
Last Name:SLAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 MILLSTREAM LN
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5600
Mailing Address - Country:US
Mailing Address - Phone:770-922-1875
Mailing Address - Fax:
Practice Address - Street 1:145 EAGLES WALK STE A
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7340
Practice Address - Country:US
Practice Address - Phone:770-389-3855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039238207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA30621981HMedicaid
GA30621981JMedicaid
GA30621981LMedicaid
GA061407OtherBC/BS OF GA GROUP #
GA30621981GMedicaid
GA30621981KMedicaid
GA30621981IMedicaid
GA30621981IMedicaid
GAP00401497Medicare PIN
GA08CBBHBMedicare PIN