Healthcare Provider Details

I. General information

NPI: 1215112321
Provider Name (Legal Business Name): TINA M. MASON, M.D., L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 RIVER CENTRE PL SUITE 200
LAWRENCEVILLE GA
30043-7322
US

IV. Provider business mailing address

935 RIVER CENTRE PL SUITE 200
LAWRENCEVILLE GA
30043-7322
US

V. Phone/Fax

Practice location:
  • Phone: 678-985-5800
  • Fax:
Mailing address:
  • Phone: 678-985-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number039405
License Number StateGA

VIII. Authorized Official

Name: MRS. MARGARETTE ANN COX
Title or Position: MEDICAL PRACTICE MANAGER
Credential:
Phone: 678-985-5800