MED FAST PC NPI 1487849857

NPI Information

NPI: 1487849857
Provider Name: MED FAST PC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 11D0941658

Address:
902 ATHENS HWY
LOGANVILLE, GA
ZIP 30052
Phone: (770) 554-5533
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MED FAST PC is a primary care clinic center in Loganville, GA. MED FAST PC NPI is 1487849857. The provider is registered as an organization entity type.

The provider's business location address is:

902 ATHENS HWY
LOGANVILLE, GA
ZIP 30052-904
Phone: (770) 554-5533
Fax: (770) 554-8129

The provider's authorized official is Elizabeth Mikrut .
The authorized official title is President and has the following contact phone number (770) 554-5533.

The CLIA number assigned to this NPI record is 11D0941658 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/10/2007 and was last updated on 9/21/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care	29730	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	GRP6328	OTHER	GEORGIA	MEDICARE GROUP

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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