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General NPI Number Information
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NPI Number | 1174916365
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Entity Type | Individual
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Provider Name | ALEXANDRIA BASS GLASS D.O.
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Gender | Female
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Dates
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Enumeration Date | 03/11/2015
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Last Update Date | 03/04/2022
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Provider Practice Location Address
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Address Line | 412 E JOHNSON ST
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City | CLINTON
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State | NC
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Zip | 28328-2806
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Country | US
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Telephone | 910-490-1240
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Fax | 910-490-1260
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Provider Business Mailing Address
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Address Line | 412 E JOHNSON ST
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City | CLINTON
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State | NC
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Zip | 28328-2806
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Country | US
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Telephone | 910-490-1240
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Fax | 910-490-1260
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 78561
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 078561
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License Number State | GA
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