=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245792233
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROGRESSIVE CARE OF GWINNETT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2019
-----------------------------------------------------
Last Update Date | 07/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 651 INDIAN TRAIL LILBURN RD NW
-----------------------------------------------------
City | LILBURN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30047-6838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-925-0088
-----------------------------------------------------
Fax | 770-925-3711
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 651 INDIAN TRAIL LILBURN RD NW
-----------------------------------------------------
City | LILBURN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30047-6838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-925-0088
-----------------------------------------------------
Fax | 770-925-3711
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. NEDA NORE
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 770-925-0088
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------