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Individual
RONNIE BASS
Active
Individual
RONNIE BASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
GA1950
GA
363A00000X
Physician Assistant
GA1950
GA
Other
Enumeration date
05/20/2014
Last updated
05/20/2014
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