Provider Demographics
NPI:1326165721
Name:BAROD OF PUBLIC EDUCATION - PAYROLL DEPARTMENT
Entity Type:Organization
Organization Name:BAROD OF PUBLIC EDUCATION - PAYROLL DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TONJA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-201-4163
Mailing Address - Street 1:208 BULL ST
Mailing Address - Street 2:ROOM 212
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-3901
Mailing Address - Country:US
Mailing Address - Phone:912-201-4163
Mailing Address - Fax:912-201-7627
Practice Address - Street 1:208 BULL ST
Practice Address - Street 2:ROOM 212
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-3901
Practice Address - Country:US
Practice Address - Phone:912-201-4163
Practice Address - Fax:912-201-7627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000772615AMedicaid