Healthcare Provider Details

I. General information

NPI: 1144353400
Provider Name (Legal Business Name): LONG COUNTY BOARD OF EDUCATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

468 S MCDONALD STREET
LUDOWICI GA
31316-6028
US

IV. Provider business mailing address

P O BOX 799
WHITE SPRINGS FL
32096-0799
US

V. Phone/Fax

Practice location:
  • Phone: 912-545-2367
  • Fax:
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 ADMINISTRATOR
Credential:
Phone: 386-884-9900