Basic Information
| Provider Information | |||||||||
| NPI: | 1952574709 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BASSIL | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | EMILE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5780 PEACHTREE DUNWOODY ROAD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043031224 | ||||||||
| FaxNumber: | 4043031325 | ||||||||
| Practice Location | |||||||||
| Address1: | 3890 JOHNS CREEK PKWY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | SUWANEE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300241284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6787752300 | ||||||||
| FaxNumber: | 6787752359 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2008 | ||||||||
| LastUpdateDate: | 08/08/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 060557 | GA | N | Other Service Providers | Specialist | 207V00000X | 060557 | GA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 877478608F | 05 | GA | MEDICAID | 877478608B | 05 | GA | MEDICAID | 877478608H | 05 | GA | MEDICAID | 877478608G | 05 | GA | MEDICAID |