Healthcare Provider Details

I. General information

NPI: 1073013306
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: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N JACKSON ST
TULLAHOMA TN
37388-3542
US

IV. Provider business mailing address

6550 CAROTHERS PKWY STE 225
FRANKLIN TN
37067-6662
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA HARLAN
Title or Position: DIRECTOR
Credential:
Phone: 615-948-9639