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General NPI Number Information
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NPI Number | 1972807865
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE PAIN MANAGEMENT, PC
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Dates
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Enumeration Date | 01/06/2011
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Last Update Date | 01/06/2011
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Provider Practice Location Address
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Address Line | 4646 N SHALLOWFORD RD
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City | ATLANTA
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State | GA
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Zip | 30338-6308
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Country | US
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Telephone | 770-676-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 4646 N SHALLOWFORD RD
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City | ATLANTA
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State | GA
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Zip | 30338-6308
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Country | US
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Telephone | 770-676-6000
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Fax |
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Authorized Official
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Title or Position | BILLING/COLLECTION SUPERVISOR
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Name | MRS. MARY C LEACH
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Credential |
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Telephone | 678-736-6342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 000186
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 038861
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 038861
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 006247
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License Number State | GA
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