Organization Name: | FASTTRACK IMMEDIATE CARE OF MILLEDGEVILLE LLC |
NPI Number: | 1366847790 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JEREMY WEBB (COO) |
Mailing Address: | 1909 N Columbia St Milledgeville |
State: | GA US |
Postal Code: | 310612170 |
Phone Number: | 4782953000 |
Fax Number: | |
NPI Enumeration Date: | 10/28/2014 |
NPI Last Update Date: | 10/28/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |