MEDICARE: FAST AND ACCURATE TEST LABS

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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1770037160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAST AND ACCURATE TEST LABS

Provider Business Mailing Address
First Line	:	1945 J N PEASE PL STE 102
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4555
Country	:	US
Telephone Number	:	980-210-1093
Fax Number	:	704-510-1763

Provider Business Practice Location Address
First Line	:	1945 J N PEASE PL STE 102
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4555
Country	:	US
Telephone Number	:	980-210-1093
Fax Number	:	704-510-1763

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARVIN STALLWORTH
Credential	:
Telephone Number	:	980-210-1093

Provider Enumeration Date	:	08/15/2016
Last Update Date	:	08/15/2016

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Directions to “FAST AND ACCURATE TEST LABS ” Practice Location

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