# BRIDGEMILL FAMILY HEALTHCARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PROGRESSIVE COMMUNITY HEALTHCARE
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1083986681
- **Legal business name:** PROGRESSIVE COMMUNITY HEALTHCARE
- **Authorized official:** MR. OTIS BONNER III (ATTORNEY)
- **Authorized official phone:** (770) 866-5488

## Contact information

- **Practice address:** 3760 SIXES RD, SUITE 120, CANTON, GA 30114-8192
- **Practice address phone:** (770) 704-4580
- **Mailing address:** 3760 SIXES RD, SUITE 120, CANTON, GA 30114-8192
- **Mailing address phone:** (770) 704-4580

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | — | GA | — |
| 207Q00000X | Family Medicine Physician | — | GA | Yes |
| 363L00000X | Nurse Practitioner | — | GA | — |

## Other

- **Enumeration date:** 01/30/2012
- **Last updated:** 01/30/2012