Provider Demographics
NPI:1487083671
Name:FASTRACK URGENT CARE LLC
Entity type:Organization
Organization Name:FASTRACK URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:SOUZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-296-2800
Mailing Address - Street 1:PO BOX 6377
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31095-6377
Mailing Address - Country:US
Mailing Address - Phone:855-491-8869
Mailing Address - Fax:855-491-8879
Practice Address - Street 1:2822 NOTTINGHAM WAY
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-7629
Practice Address - Country:US
Practice Address - Phone:855-491-8869
Practice Address - Fax:855-491-8879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center