Healthcare Provider Details

I. General information

NPI: 1770646960
Provider Name (Legal Business Name): GLASCOCK COUNTY BOE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 PANTHER WAY
GIBSON GA
30810-4238
US

IV. Provider business mailing address

PO BOX 799
WHITE SPRINGS FL
32096-0799
US

V. Phone/Fax

Practice location:
  • Phone: 706-598-2121
  • Fax: 706-598-2526
Mailing address:
  • Phone: 386-884-9900
  • Fax: 888-737-1652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JOHN L. VASSAR JR.
Title or Position: BILLING ADMINISTRATION
Credential:
Phone: 386-884-9900