Provider Demographics
NPI:1851002463
Name:POLLARD, SAM (BSW, C-SWCM, SST, ST)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:POLLARD
Suffix:
Gender:M
Credentials:BSW, C-SWCM, SST, ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 COHEN WALKER DR APT 2703
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047-2774
Mailing Address - Country:US
Mailing Address - Phone:910-578-1703
Mailing Address - Fax:
Practice Address - Street 1:940 SR 96
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088
Practice Address - Country:US
Practice Address - Phone:229-815-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker