Provider Demographics
NPI:1639432008
Name:PROGRESSIVE PAIN CENTERS
Entity Type:Organization
Organization Name:PROGRESSIVE PAIN CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:LESLIE
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:404-241-7062
Mailing Address - Street 1:PO BOX 360939
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30036-0939
Mailing Address - Country:US
Mailing Address - Phone:404-241-7062
Mailing Address - Fax:404-243-0357
Practice Address - Street 1:3009 RAINBOW DR
Practice Address - Street 2:SUITE 139
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-1680
Practice Address - Country:US
Practice Address - Phone:404-241-7062
Practice Address - Fax:404-243-0357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-20
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO08531111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty