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Contact Information

CHARLES M BASS JR, PA
1485 JESSE JEWELL PKWY NE STE 220A
GAINESVILLE, GA30501
 Phone: 770-740-1860
 Fax: 678-347-2104
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for CHARLES M BASS JR · (Male)

NPI Number 1306100979
Status Active
Credentials PA (Physician Assistant)
Entity Individual
Enumeration date 06/28/2012
Last updated 09/20/2018 - About 8 years ago
Sole proprietor 1 No
Identifiers
  • GA License # 006476
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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