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Organization

MED FAST PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ELIZABETH MIKRUT MD (PRESIDENT)
(770) 554-5533
Entity
Organization

Contact information

Practice address
902 ATHENS HWY, LOGANVILLE, GA 30052-4904
(770) 554-5533
(770) 554-8129
Mailing address
902 ATHENS HWY, LOGANVILLE, GA 30052-4904
(770) 554-5533
(770) 554-8129

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
29730
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
GRP6328
MEDICARE GROUP
GA
Enumeration date
09/10/2007
Last updated
09/21/2007
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