Provider Demographics
NPI:1174892392
Name:PROGRESSIVE HEALTHCARE OF GWINNETT LLC
Entity type:Organization
Organization Name:PROGRESSIVE HEALTHCARE OF GWINNETT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:LEW
Authorized Official - Last Name:RATTINER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-579-2225
Mailing Address - Street 1:670 INDIAN TRAIL LILBURN RD NW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-1716
Mailing Address - Country:US
Mailing Address - Phone:770-925-0088
Mailing Address - Fax:770-925-3711
Practice Address - Street 1:670 INDIAN TRAIL LILBURN RD NW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-1716
Practice Address - Country:US
Practice Address - Phone:770-925-0088
Practice Address - Fax:770-925-3711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA37957208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty