Healthcare Provider Details

I. General information

NPI: 1427094549
Provider Name (Legal Business Name): KEVIN D MASON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KEVIN DENNIS MASON

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 FRANKLIN RD SE
MARIETTA GA
30067-8721
US

IV. Provider business mailing address

720 WESTVIEW DR SW
ATLANTA GA
30310-1458
US

V. Phone/Fax

Practice location:
  • Phone: 770-951-5400
  • Fax: 770-951-5408
Mailing address:
  • Phone: 770-951-5400
  • Fax: 770-951-5408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number028604
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: