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General NPI Number Information
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NPI Number | 1043975402
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Entity Type | Organization
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Legal Business Name | FAST PACE MEDICAL CLINIC PLLC
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Dates
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Enumeration Date | 11/01/2021
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Last Update Date | 10/28/2022
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Provider Practice Location Address
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Address Line | 41357 US HIGHWAY 280 SUITE B
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City | SYLACAUGA
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State | AL
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Zip | 35150-8046
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Country | US
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Telephone | 312-531-1109
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Fax | 317-229-9199
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Provider Business Mailing Address
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Address Line | PO BOX 306244
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City | NASHVILLE
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State | TN
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Zip | 37230-6244
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | SYDNI CLEMMONS
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Credential |
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Telephone | 901-351-1791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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