Fasttrack Ic Ancillary LLC

NPI #1780134411 in Dublin, Georgia

Provider Information

NPI Number: 1780134411
Entity Type: Organization
Organization Name: Fasttrack Ic Ancillary LLC
Primary Specialty: Specialist
Enumeration Date: Oct 5, 2016
Last Updated: Oct 5, 2016

Practice Location

Address: 1110 HILLCREST PKWY
Address 2: UNIT #C
City: Dublin
State: Georgia
ZIP Code: 31021-3687
Phone: (478) 296-2800

Authorized Official

Name: JARED DERANEY
Title: PRESIDENT
Phone: (888) 728-0882

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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