Healthcare Provider Details

I. General information

NPI: 1477079580
Provider Name (Legal Business Name): MR. DENNIS PAYNE MASON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 08/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4751 BEST RD STE 300
ATLANTA GA
30337-5600
US

IV. Provider business mailing address

4751 BEST RD STE 300
ATLANTA GA
30337-5600
US

V. Phone/Fax

Practice location:
  • Phone: 844-856-7907
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: