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Organization
PROGRESSIVE MEDICAL CLINIC LLC
Active
Organization
PROGRESSIVE MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN MITCHELL (OWNER)
(770) 614-4060
Entity
Organization
Contact information
Practice address
2098 TERON TRCE STE 300, DACULA, GA 30019-1667
(770) 614-4060
(678) 482-7788
Mailing address
2098 TERON TRCE STE 300, DACULA, GA 30019-1667
(770) 614-4060
(678) 482-7788
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
—
NULL
207QA0505X
Adult Medicine Physician
Primary
—
—
208D00000X
General Practice Physician
—
NULL
208D00000X
General Practice Physician
—
—
Other
Enumeration date
12/09/2020
Last updated
02/19/2021
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