Med Fast PC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

29730 Issued in GA

Legal business name

MED FAST PC

Practice address

902 Athens Hwy
Loganville, GA 30052-4904

Phone

(770) 554-5533

Fax

(770) 554-8129

NPI assigned

Sep 10, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Elizabeth Mikrut, MDNPI 1760530778

Title

President

Phone

(770) 554-5533

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Elizabeth Mikrut, MD

  • Family Medicine Physician
  • Loganville, GA
  • NPI 1760530778
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190332800000",
    "number": "1487849857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 ATHENS HWY",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300524904",
            "telephone_number": "770-554-5533",
            "fax_number": "770-554-8129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 ATHENS HWY",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300524904",
            "telephone_number": "770-554-5533",
            "fax_number": "770-554-8129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED FAST PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-10",
        "last_updated": "2007-09-21",
        "status": "A",
        "authorized_official_last_name": "MIKRUT",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-554-5533",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "29730",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "GRP6328",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joseph McLain, DMD
• Jennifer McManus, COTA/L
• Mariah McMorris
• Mdcare Clinic LLC
• Patricia Meadows, PTA
• Medcare Transport Inc
• Medical Elite Network Corp
• Nilton D Medina, MD
• Medipractic LLC
• Medipractic LLC

• Primary Care Clinic/Center in Loganville, GA
• Providers in Loganville, GA by specialty
• Primary Care Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.