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PROGRESSIVE COMMUNITY HEALTHCARE NPI 1407877764


NPI Information

NPI: 1407877764
Provider Name: PROGRESSIVE COMMUNITY HEALTHCARE
Classification: Family Medicine - 207QA0505X
Entity Type: Organization

Specialization: Adult Medicine

Address:
494 BOULEVARD SE
ATLANTA, GA
ZIP 30312
Phone: (404) 607-1002
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PROGRESSIVE COMMUNITY HEALTHCARE is an adult medicine family medicine in Atlanta, GA. The provider is the National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code. PROGRESSIVE COMMUNITY HEALTHCARE NPI is 1407877764. The provider is registered as an organization entity type.

The provider's business location address is:

494 BOULEVARD SE
ATLANTA, GA
ZIP 30312-426
Phone: (404) 607-1002
Fax: (404) 607-1031

The provider's authorized official is Quatoya R Tyson .
The authorized official title is Clinical Office Coordinator and has the following contact phone number (404) 607-1002.

The enumeration date for this NPI number is 7/22/2006 and was last updated on 12/13/2011.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261Q00000XClinic/CenterGEORGIANo
2207QA0505XFamily MedicineAdult MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1GRP7609MEDICARE UPINGEORGIA
2229783620BMEDICAIDGEORGIA
3GRP7609MEDICARE ID-TYPE UNSPECIFIEDGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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