Organization
PROGRESSIVE COMMUNITY HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. QUATOYA R TYSON (CLINICAL OFFICE COORDINATOR)
(404) 607-1002
Entity
Organization
Contact information
Practice address
494 BOULEVARD SE, ATLANTA, GA 30312-3426
(404) 607-1002
(404) 607-1031
Mailing address
PO BOX 54723, ATLANTA, GA 30308
(404) 607-1002
(404) 607-1031
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
—
—
261Q00000X
Clinic/Center
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
229783620B
—
GA
Enumeration date
07/22/2006
Last updated
12/13/2011
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