Provider Demographics
NPI:1326111410
Name:BASSETT, WILBUR B JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILBUR
Middle Name:B
Last Name:BASSETT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 590
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31902-0590
Mailing Address - Country:US
Mailing Address - Phone:706-320-8780
Mailing Address - Fax:706-660-2583
Practice Address - Street 1:1831 5TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904
Practice Address - Country:US
Practice Address - Phone:706-320-8780
Practice Address - Fax:706-660-2583
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016208207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA305061OtherWELLCARE
900003753OtherRR MEDICARE
GA00153458EMedicaid
582578648OtherEVERGREEN
582578648319B001OtherTRICARE WPS
AL60016717OtherBCBS
4282795OtherAETNA
GA3790OtherBCBS
GA3790OtherBCBS
90BDBKNMedicare ID - Type Unspecified