Provider Demographics
NPI:1497441158
Name:BASS, JAIME LYNNE (NP)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:LYNNE
Last Name:BASS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 WALLACE WELLS CIR
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:GA
Mailing Address - Zip Code:30817-2802
Mailing Address - Country:US
Mailing Address - Phone:912-258-1964
Mailing Address - Fax:
Practice Address - Street 1:707 OLD DALTON ELLIJAY RD
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-2029
Practice Address - Country:US
Practice Address - Phone:706-695-4564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN254900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily