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General NPI Number Information
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NPI Number | 1548364755
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Entity Type | Individual
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Provider Name | WALLINE T BASS N.P.
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Gender | Female
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Dates
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Enumeration Date | 09/08/2006
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Last Update Date | 06/10/2024
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Provider Practice Location Address
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Address Line | 1525 CLIFTON RD NE SUITE 207
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City | ATLANTA
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State | GA
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Zip | 30322-4200
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Country | US
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Telephone | 404-778-4451
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Fax | 404-778-4355
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Provider Business Mailing Address
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Address Line | 200 CORPORATE BLVD
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City | LAFAYETTE
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State | LA
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Zip | 70508-3870
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Country | US
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Telephone | 800-893-9698
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN102335
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License Number State | GA
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