Provider Demographics
NPI:1306100979
Name:BASS, CHARLES MARCUS JR (PA)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:MARCUS
Last Name:BASS
Suffix:JR
Gender:M
Credentials:PA
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Mailing Address - Street 1:925 N POINT PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-5211
Mailing Address - Country:US
Mailing Address - Phone:770-740-1860
Mailing Address - Fax:678-347-2104
Practice Address - Street 1:1485 JESSE JEWELL PKWY NE STE 220A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:770-740-1860
Practice Address - Fax:678-347-2104
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2018-09-20
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Provider Licenses
StateLicense IDTaxonomies
GA006476363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant