Provider Demographics
NPI:1154598324
Name:PROGRESSIVE WOMEN'S HEALTHCARE
Entity type:Organization
Organization Name:PROGRESSIVE WOMEN'S HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ULRICA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-223-2229
Mailing Address - Street 1:PO BOX 42827
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311
Mailing Address - Country:US
Mailing Address - Phone:404-223-2229
Mailing Address - Fax:404-223-2191
Practice Address - Street 1:10 PARK PLACE SE
Practice Address - Street 2:SUITE LLC
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-9998
Practice Address - Country:US
Practice Address - Phone:404-699-7096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1568521052Medicaid
GA1467510313Medicaid
GA1154598324Medicaid