Provider Demographics
NPI:1235292244
Name:BUTTS COUNTY BOE
Entity Type:Organization
Organization Name:BUTTS COUNTY BOE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:VASSAR
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:386-884-9900
Mailing Address - Street 1:PO BOX 799
Mailing Address - Street 2:
Mailing Address - City:WHITE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32096-0799
Mailing Address - Country:US
Mailing Address - Phone:386-884-9900
Mailing Address - Fax:888-737-1652
Practice Address - Street 1:181 N MULBERRY ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:GA
Practice Address - Zip Code:30233-1934
Practice Address - Country:US
Practice Address - Phone:770-504-2300
Practice Address - Fax:770-504-2305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000798003AMedicaid