Healthcare Provider Details

I. General information

NPI: 1821063678
Provider Name (Legal Business Name): CAMILLE L MASON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2526 HIGHWAY 72 E
ABBEVILLE SC
29620-5254
US

IV. Provider business mailing address

2526 HIGHWAY 72 E
ABBEVILLE SC
29620-5254
US

V. Phone/Fax

Practice location:
  • Phone: 864-227-2822
  • Fax: 864-227-3410
Mailing address:
  • Phone: 864-227-2822
  • Fax: 864-227-3410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberM6749
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberM6749
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberM6749
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: