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General NPI Number Information
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NPI Number | 1497254627
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Entity Type | Individual
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Provider Name | MASON WESTON BRILES MS, LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 02/02/2018
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Last Update Date | 07/11/2022
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Provider Practice Location Address
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Address Line | 26 EAGLE ROW NE
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City | ATLANTA
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State | GA
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Zip | 30322-3500
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Country | US
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Telephone | 770-827-4018
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Fax |
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Provider Business Mailing Address
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Address Line | 1643 BRIARCLIFF RD NE APT 1
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City | ATLANTA
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State | GA
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Zip | 30306-2141
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Country | US
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Telephone | 770-827-4018
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT003577
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License Number State | GA
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