Organization
POLK SCHOOL DISTRICT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN L VASSAR (BILLING ADMINISTRATOR)
(386) 884-9900
Entity
Organization
Contact information
Practice address
612 S COLLEGE ST, CEDARTOWN, GA 30125-3522
(770) 684-8718
(770) 684-3221
Mailing address
PO BOX 128, 612 S. COLLEGE ST, CEDARTOWN, GA 30125
(770) 748-3821
(770) 748-5131
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
235Z00000N
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000795935A
—
GA
01
—
103071
WEB PORTAL SUBMISSION NUMBER
—
Enumeration date
12/06/2006
Last updated
10/09/2012
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