Provider Demographics
NPI:1598758252
Name:BASSETT, CHRISTOPHER J (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:BASSETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1011 PARKSIDE CMNS
Mailing Address - Street 2:UNIT 101
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-4534
Mailing Address - Country:US
Mailing Address - Phone:706-454-1210
Mailing Address - Fax:706-454-1211
Practice Address - Street 1:1011 PARKSIDE CMNS
Practice Address - Street 2:UNIT 101
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-4534
Practice Address - Country:US
Practice Address - Phone:706-454-1210
Practice Address - Fax:706-454-1211
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA057574208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI07369Medicare UPIN