Provider Demographics
NPI:1831314434
Name:GAINESVILLE CITY SCHOOL SYSTEM
Entity Type:Organization
Organization Name:GAINESVILLE CITY SCHOOL SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:VASSAR
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:386-884-9900
Mailing Address - Street 1:508 OAK ST NW
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3576
Mailing Address - Country:US
Mailing Address - Phone:770-287-2004
Mailing Address - Fax:770-536-5275
Practice Address - Street 1:508 OAK ST NW
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3576
Practice Address - Country:US
Practice Address - Phone:770-287-2004
Practice Address - Fax:770-536-5275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000768743AOther99
GA000768743AMedicaid