Polk School District

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

235Z00000N Issued in GA

Legal business name

POLK SCHOOL DISTRICT

Practice address

612 S College St
Cedartown, GA 30125-3522

Phone

(770) 684-8718

Fax

(770) 684-3221

NPI assigned

Dec 6, 2006

Reactivated

Sep 16, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John L Vassar

Title

Billing Administrator

Phone

(386) 884-9900

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349740800000",
    "number": "1427117761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 128",
            "address_2": "612 S. COLLEGE ST",
            "city": "CEDARTOWN",
            "state": "GA",
            "postal_code": "30125",
            "telephone_number": "770-748-3821",
            "fax_number": "770-748-5131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 S COLLEGE ST",
            "city": "CEDARTOWN",
            "state": "GA",
            "postal_code": "301253522",
            "telephone_number": "770-684-8718",
            "fax_number": "770-684-3221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLK SCHOOL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2012-10-09",
        "deactivation_date": "2008-06-03",
        "reactivation_date": "2008-09-16",
        "status": "A",
        "authorized_official_last_name": "VASSAR",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BILLING ADMINISTRATOR",
        "authorized_official_telephone_number": "386-884-9900"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "235Z00000N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WEB PORTAL SUBMISSION NUMBER",
            "identifier": "103071",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000795935A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Polk County Board of Health
• Polk County Emergency Medical Service
• Polk County, Ga Board of Commissioners
• Polk Medical Center, Inc
• Polk Medical Center, Inc
• Jhinora Pollard
• Popham Eyecare LLC
• Charles Ray Popham, OD
• John Thomas Popham
• Praise Pediatric Therapy LLC

• Speech-Language Pathologist in Cedartown, GA
• Providers in Cedartown, GA by specialty
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.