Provider Demographics
NPI:1174074710
Name:SOUTHWEST GEORGIA S T E M CHARTER INC
Entity type:Organization
Organization Name:SOUTHWEST GEORGIA S T E M CHARTER INC
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:
Authorized Official - Credentials:
Authorized Official - Phone:386-884-9900
Mailing Address - Street 1:PO BOX 300
Mailing Address - Street 2:
Mailing Address - City:SHELLMAN
Mailing Address - State:GA
Mailing Address - Zip Code:39886-0300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:185 PECAN ST
Practice Address - Street 2:
Practice Address - City:SHELLMAN
Practice Address - State:GA
Practice Address - Zip Code:39886-2548
Practice Address - Country:US
Practice Address - Phone:229-679-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)