Individual
ANNALYCE BASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-BC
Contact information
Practice address
745 GLYNN ST S, FAYETTEVILLE, GA 30214-2049
(770) 719-5490
Mailing address
190 LITTLE CREEK DR, FAYETTEVILLE, GA 30214-7235
(404) 556-7108
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
327997
GA
363LF0000X
Family Nurse Practitioner
Primary
327997
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
236
—
DC
01
—
568946544
BCBS
—
01
—
5874
HEALTH PARTNERS
—
Enumeration date
03/18/2024
Last updated
03/18/2024
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