Healthcare Provider Details

I. General information

NPI: 1174416622
Provider Name (Legal Business Name): PROGRESSIVE MEDICAL CENTERS OF AMERICA LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 N SHALLOWFORD RD
ATLANTA GA
30338-6308
US

IV. Provider business mailing address

4646 N SHALLOWFORD RD
ATLANTA GA
30338-6308
US

V. Phone/Fax

Practice location:
  • Phone: 770-676-6000
  • Fax: 844-313-6296
Mailing address:
  • Phone: 770-676-6000
  • Fax: 844-313-6296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MISS CAROL THOMPSON
Title or Position: BILLING MANAGER
Credential:
Phone: 770-676-6000