Organization
BRIDGEMILL FAMILY HEALTHCARE, LLC
Active
Parent organization
PROGRESSIVE COMMUNITY HEALTHCARE
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROGRESSIVE COMMUNITY HEALTHCARE
Authorized official
MR. OTIS BONNER III (ATTORNEY)
(770) 866-5488
Entity
Organization
Contact information
Practice address
3760 SIXES RD, SUITE 120, CANTON, GA 30114-8192
(770) 704-4580
Mailing address
3760 SIXES RD, SUITE 120, CANTON, GA 30114-8192
(770) 704-4580
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
GA
207Q00000X
Family Medicine Physician
Primary
—
GA
363L00000X
Nurse Practitioner
—
GA
Other
Enumeration date
01/30/2012
Last updated
01/30/2012
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