Healthcare Provider Details

I. General information

NPI: 1124528468
Provider Name (Legal Business Name): FAST PACE MEDICAL CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BEAR PKWY
LINCOLN AL
35096-6798
US

IV. Provider business mailing address

6550 CAROTHERS PKWY STE 225
FRANKLIN TN
37067-6662
US

V. Phone/Fax

Practice location:
  • Phone: 423-746-5973
  • Fax:
Mailing address:
  • Phone: 931-253-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SYDNI CLEMMONS
Title or Position: COO
Credential:
Phone: 931-253-1110