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NPI Code Detail

MEDICARE: DR. EDWARD KING BASS III M.D.

MEDICARE: DR. EDWARD KING BASS III M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician049270GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205811262
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDWARD KING BASS III M.D.
Provider Business Mailing Address
First Line : PO BOX 561
Second Line :
City : SYLVESTER
State : GA
Zip : 31791-0561
Country : US
Telephone Number : 229-776-2965
Fax Number : 229-776-4452
Provider Business Practice Location Address
First Line : 1014 W FRANKLIN ST
Second Line :
City : SYLVESTER
State : GA
Zip : 31791-1978
Country : US
Telephone Number : 229-776-2965
Fax Number : 229-776-4452
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2005
Last Update Date : 09/27/2010

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