Healthcare Provider Details

I. General information

NPI: 1114181542
Provider Name (Legal Business Name): PROGRESSIVE HEALTH CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 THORNTON RD
LITHIA SPRINGS GA
30122
US

IV. Provider business mailing address

PO BOX 500067
ATLANTA GA
31150
US

V. Phone/Fax

Practice location:
  • Phone: 678-236-0600
  • Fax: 678-236-0601
Mailing address:
  • Phone: 678-701-2225
  • Fax: 678-701-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. PATRICIA BENTON
Title or Position: CEO
Credential: MD
Phone: 678-701-2225