Individual
MR. CHARLES EDWARD BASS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPT
Contact information
Practice address
101 FAIRVIEW PARK DR, DUBLIN, GA 31021-2501
(478) 272-7494
(478) 272-2616
Mailing address
PO BOX 883, DUBLIN, GA 31040-0883
(478) 272-7494
(478) 272-2616
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1787
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000562504C
—
GA
05
—
000562594F
—
GA
Enumeration date
01/30/2006
Last updated
06/29/2023
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