MEDICARE: PROGRESSIVE SPINAL & REHAB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	006388	GA

General Provider Information

NPI Number	:	1538419981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE SPINAL & REHAB

Provider Business Mailing Address
First Line	:	777 CLEVELAND AVE SW STE 406
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-7119
Country	:	US
Telephone Number	:	770-876-6972
Fax Number	:	770-452-2844

Provider Business Practice Location Address
First Line	:	777 CLEVELAND AVE SW STE 406
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-7119
Country	:	US
Telephone Number	:	770-876-6972
Fax Number	:	770-452-2844

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	BRIAN BONNER
Credential	:	DC
Telephone Number	:	770-876-6972

Provider Enumeration Date	:	09/13/2012
Last Update Date	:	09/13/2012

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Directions to “PROGRESSIVE SPINAL & REHAB ” Practice Location

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