Healthcare Provider Details

I. General information

NPI: 1073661690
Provider Name (Legal Business Name): FASTMED PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S. MAIN ST
WAKE FOREST NC
27587
US

IV. Provider business mailing address

935 SHOTWELL RD SUITE 108
CLAYTON NC
27520
US

V. Phone/Fax

Practice location:
  • Phone: 919-562-3155
  • Fax: 919-562-7401
Mailing address:
  • Phone: 919-562-3155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NENA REEVES
Title or Position: DIRECTOR OF BUSINESS DEVELOPMENT
Credential:
Phone: 919-550-0821