Healthcare Provider Details

I. General information

NPI: 1366244253
Provider Name (Legal Business Name): MARIAH AMIA CASON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 POOLER PKWY
POOLER GA
31322-4264
US

IV. Provider business mailing address

1150 E PERRY LN APT 1409
SAVANNAH GA
31401-1282
US

V. Phone/Fax

Practice location:
  • Phone: 912-330-4095
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN124187
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: