Provider Demographics
NPI:1649413238
Name:PROGRESSIVE MEDICAL CENTER, PC
Entity Type:Organization
Organization Name:PROGRESSIVE MEDICAL CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MATALONE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:770-676-6000
Mailing Address - Street 1:4646 N SHALLOWFORD RD
Mailing Address - Street 2:#500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6308
Mailing Address - Country:US
Mailing Address - Phone:770-676-6000
Mailing Address - Fax:
Practice Address - Street 1:4646 N SHALLOWFORD RD
Practice Address - Street 2:#500
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6308
Practice Address - Country:US
Practice Address - Phone:770-676-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-12
Last Update Date:2009-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty