Provider Demographics
NPI:1902331770
Name:FASTENP LLC ( 24 HOURS MOBILE URGENT /PRIMARY CARE)
Entity Type:Organization
Organization Name:FASTENP LLC ( 24 HOURS MOBILE URGENT /PRIMARY CARE)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MINKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-699-8220
Mailing Address - Street 1:2766 ABILENE LN
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6436
Mailing Address - Country:US
Mailing Address - Phone:678-687-3376
Mailing Address - Fax:
Practice Address - Street 1:2766 ABILENE LN
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6436
Practice Address - Country:US
Practice Address - Phone:678-687-3376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2017OCC-006713253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1457737892OtherNPI ENUMERATOR