Provider Demographics
NPI:1528231602
Name:REBECCA L BASS MD - PULMONARY MEDICINE PC
Entity Type:Organization
Organization Name:REBECCA L BASS MD - PULMONARY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO, OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUDSON
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCCURDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-757-1411
Mailing Address - Street 1:420 CHARTER BLVD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4854
Mailing Address - Country:US
Mailing Address - Phone:478-757-1411
Mailing Address - Fax:478-757-1288
Practice Address - Street 1:420 CHARTER BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-4854
Practice Address - Country:US
Practice Address - Phone:478-757-1411
Practice Address - Fax:478-757-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041074174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty