Healthcare Provider Details

I. General information

NPI: 1023538279
Provider Name (Legal Business Name): SARBJIT SINGH MASSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 BROADRICK DR
DALTON GA
30720-3009
US

IV. Provider business mailing address

1432 BROADRICK DR
DALTON GA
30720-3009
US

V. Phone/Fax

Practice location:
  • Phone: 706-226-8990
  • Fax: 706-529-5313
Mailing address:
  • Phone: 706-226-8990
  • Fax: 706-529-5313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number86087
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: