Provider Demographics
NPI:1053715631
Name:PROACTIVE MEDICAL TRAINING CENTER INC
Entity type:Organization
Organization Name:PROACTIVE MEDICAL TRAINING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNATHAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-438-9190
Mailing Address - Street 1:3644 CHAMBLEE TUCKER RD STE F
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4405
Mailing Address - Country:US
Mailing Address - Phone:770-621-0001
Mailing Address - Fax:
Practice Address - Street 1:3644 CHAMBLEE TUCKER RD STE F
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4405
Practice Address - Country:US
Practice Address - Phone:770-621-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-10
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty