=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134452865
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAST PACE MEDICAL CLINIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2009
-----------------------------------------------------
Last Update Date | 11/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3813 OLD PORT ROYAL RD N
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37174-2813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-487-1006
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1258
-----------------------------------------------------
City | WAYNESBORO
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38485-1258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-722-9099
-----------------------------------------------------
Fax | 931-722-9919
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SR MANAGER
-----------------------------------------------------
Name | CHRISTY LITTLEJOHN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 931-253-1110
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------