Individual
JOHN H POLAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1350 WALTON WAY, AUGUSTA, GA 30901-2612
(904) 805-1300
(904) 805-1302
Mailing address
PO BOX 532780, ATLANTA, GA 30353-2780
(904) 805-1300
(904) 805-1302
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
31100
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000403807C
—
GA
01
—
623872
BLUE CROSS
GA
01
—
G31100
SOUTH CAROLINA MEDICAID
SC
05
—
G31100
—
SC
Enumeration date
06/23/2006
Last updated
04/01/2008
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