Healthcare Provider Details

I. General information

NPI: 1407094196
Provider Name (Legal Business Name): PUTNAM COUNTY BOARD OF EDUCATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 02/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 OLD GLENWOOD SPRINGS RD
EATONTON GA
31024-6525
US

IV. Provider business mailing address

PO BOX 799
WHITE SPRINGS FL
32096-0799
US

V. Phone/Fax

Practice location:
  • Phone: 706-485-5381
  • Fax:
Mailing address:
  • Phone: 800-565-2162
  • Fax: 888-737-1652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number000776146
License Number StateGA

VIII. Authorized Official

Name: MR. JOHN L VASSAR JR.
Title or Position: BILLING ADMINISTRATOR
Credential:
Phone: 800-565-2162