Fasttrack Ic Ancillary LLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

FASTTRACK IC ANCILLARY LLC

Practice address

1110 Hillcrest Pkwy
Unit #C
Dublin, GA 31021-3687

Phone

(478) 296-2800

NPI assigned

Oct 5, 2016

Organization subpart

No

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

Authorized official

Name

Jared Deraney

Title

President

Phone

(888) 728-0882

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1475625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475625600000",
    "number": "1780134411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4380",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300234380",
            "telephone_number": "888-728-0882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 HILLCREST PKWY",
            "address_2": "UNIT #C",
            "city": "DUBLIN",
            "state": "GA",
            "postal_code": "310213687",
            "telephone_number": "478-296-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FASTTRACK IC ANCILLARY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-05",
        "last_updated": "2016-10-05",
        "status": "A",
        "authorized_official_last_name": "DERANEY",
        "authorized_official_first_name": "JARED",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "888-728-0882"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Family Dentistry of Dublin, P.C.
• Family Focus Health Services
• Family Focus Health Services
• Family Focus Health Services, LLC
• John H. Fas0N, D.M.D.
• Fasttrack Immediate Care of Dublin, LLC
• Dayana Ferguson
• Amanda Cristina Fiala, LCSW
• Nomie Gagalang Finn, MD
• First Choice Family Chiropractic Center of Dublin LLC

• Specialist in Dublin, GA
• Providers in Dublin, GA by specialty
• Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.