Individual
PATRICIA ROSE BAST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
780 CANTON RD NE, STE 200, MARIETTA, GA 30060
(770) 285-8026
Mailing address
780 CANTON RD NE, STE 200, MARIETTA, GA 30060
(770) 285-8026
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
—
GA
208000000X
Pediatrics Physician
20A14128
CA
208000000X
Pediatrics Physician
Primary
82246
GA
208D00000X
General Practice Physician
82246
GA
Other
Enumeration date
05/02/2013
Last updated
04/21/2023
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