Organization Name: | PROGRESSIVE HEALTHCARE OF GWINNETT LLC |
NPI Number: | 1174892392 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DENNIS LEW RATTINER (OWNER) |
Mailing Address: | 670 Indian Trail Lilburn Rd Nw Lilburn |
State: | GA US |
Postal Code: | 300471716 |
Phone Number: | 7709250088 |
Fax Number: | 7709253711 |
NPI Enumeration Date: | 12/16/2011 |
NPI Last Update Date: | 12/16/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 37957 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |