MEDICARE: FASTMED HEALTH NC, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1609332725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FASTMED HEALTH NC, PLLC

Provider Business Mailing Address
First Line	:	935 SHOTWELL RD STE 108
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27520-5598
Country	:	US
Telephone Number	:	804-500-2285
Fax Number	:	199-882-9575

Provider Business Practice Location Address
First Line	:	150 FRANCAM DR
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28311-4500
Country	:	US
Telephone Number	:	910-487-1100
Fax Number	:	910-884-9821

Authorized Official
Title or Position	:	NATIONAL SENIOR MANAGER
Name	:	ASHANTA LEWIS
Credential	:
Telephone Number	:	713-520-2007

Provider Enumeration Date	:	02/13/2019
Last Update Date	:	03/12/2020

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