Individual
DR. EDWARD KING BASS III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1014 W FRANKLIN ST, SYLVESTER, GA 31791-1978
(229) 776-2965
(229) 776-4452
Mailing address
PO BOX 561, SYLVESTER, GA 31791-0561
(229) 776-2965
(229) 776-4452
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
049270
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00892196C
—
GA
05
—
00892196D
—
GA
Enumeration date
12/13/2005
Last updated
09/27/2010
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