Healthcare Provider Details

I. General information

NPI: 1912140484
Provider Name (Legal Business Name): THE PROGRESS PLACE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 PARKLAKE DR NE STE 415
ATLANTA GA
30345-2896
US

IV. Provider business mailing address

2302 PARKLAKE DR NE STE 415
ATLANTA GA
30345-2896
US

V. Phone/Fax

Practice location:
  • Phone: 678-894-0288
  • Fax: 336-791-2188
Mailing address:
  • Phone: 678-894-0288
  • Fax: 336-791-2188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TONICA ANGEL LOGAN
Title or Position: CEO
Credential:
Phone: 678-894-0288