Basic Information
| Provider Information | |||||||||
| NPI: | 1518626225 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAST PACE MISSISSIPPI, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 306415 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372306415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9312531110 | ||||||||
| FaxNumber: | 9317229919 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 HIGHWAY 16 W | ||||||||
| Address2: | |||||||||
| City: | CARTHAGE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390514240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012983101 | ||||||||
| FaxNumber: | 9317229919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2021 | ||||||||
| LastUpdateDate: | 12/09/2021 | ||||||||
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| AuthorizedOfficialLastName: | CLEMMONS | ||||||||
| AuthorizedOfficialFirstName: | SYDNI | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9013511791 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.