Organization
FAST PACE MEDICAL CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SYDNI CLEMMONS (CREDENTIALING MANAGER)
(901) 351-1791
Entity
Organization
Contact information
Practice address
4152 W STATE ROAD 56, HANOVER, IN 47243-9070
(812) 762-4510
Mailing address
PO BOX 1258, WAYNESBORO, TN 38485-1258
(931) 253-1110
(931) 722-9919
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
IN
Enumeration date
02/13/2018
Last updated
07/15/2021
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