Individual
DR. JAVAN S. BASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
8225 MALL PKWY, LITHONIA, GA 30038-6994
(770) 484-9599
Mailing address
302 PROVIDENCE DR, DALLAS, GA 30157-7465
(334) 538-1020
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
POD001101
GA
213ES0103X
Foot & Ankle Surgery Podiatrist
SC006097
PA
Other
Enumeration date
07/02/2009
Last updated
02/23/2010
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