Healthcare Provider Details

I. General information

NPI: 1093190837
Provider Name (Legal Business Name): FAST SURGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 HOSPITAL RD
CANTON GA
30114-2408
US

IV. Provider business mailing address

PO BOX 1186
BALL GROUND GA
30107-1102
US

V. Phone/Fax

Practice location:
  • Phone: 770-720-5100
  • Fax:
Mailing address:
  • Phone: 770-480-1311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number153136
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number151286
License Number StateGA

VIII. Authorized Official

Name: TRACY C ECHUCK
Title or Position: PRESIDENT
Credential: CSFA
Phone: 770-480-1311