Provider Demographics
NPI:1417109646
Name:COMMERCE CITY SCHOOLS
Entity Type:Organization
Organization Name:COMMERCE CITY SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-335-5500
Mailing Address - Street 1:270 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529-2632
Mailing Address - Country:US
Mailing Address - Phone:706-335-5500
Mailing Address - Fax:706-335-2796
Practice Address - Street 1:270 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-2632
Practice Address - Country:US
Practice Address - Phone:706-335-5500
Practice Address - Fax:706-335-2796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000776124BOtherGEORGIA MEDICAID PROVIDER ENROLLMENT