Healthcare Provider Details

I. General information

NPI: 1841125390
Provider Name (Legal Business Name): SEMON MASON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3608 HULL ST
RICHMOND VA
23224-3447
US

IV. Provider business mailing address

PO BOX 9201
RICHMOND VA
23227-0201
US

V. Phone/Fax

Practice location:
  • Phone: 404-735-5681
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: