Provider Demographics
NPI:1548481005
Name:BASS, NINA BRAZELL (MD)
Entity type:Individual
Prefix:DR
First Name:NINA
Middle Name:BRAZELL
Last Name:BASS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 11989
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30355-1989
Mailing Address - Country:US
Mailing Address - Phone:404-814-0733
Mailing Address - Fax:404-814-0584
Practice Address - Street 1:2967 GRANDVIEW AVENUE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305
Practice Address - Country:US
Practice Address - Phone:404-814-0733
Practice Address - Fax:404-814-0584
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0315592084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry