Provider Demographics
NPI:1245792233
Name:PROGRESSIVE CARE OF GWINNETT LLC
Entity Type:Organization
Organization Name:PROGRESSIVE CARE OF GWINNETT LLC
Other - Org Name:PROGRESSIVE HEALTHCARE OF GWINNETT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-925-0088
Mailing Address - Street 1:670 INDIAN TRAIL LILBURN RD NW STE D
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-6888
Mailing Address - Country:US
Mailing Address - Phone:770-925-0088
Mailing Address - Fax:770-925-3711
Practice Address - Street 1:670 INDIAN TRAIL LILBURN RD NW STE D
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-6888
Practice Address - Country:US
Practice Address - Phone:770-925-0088
Practice Address - Fax:770-925-3711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-01
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA064758OtherUPTOM