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General NPI Number Information
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NPI Number | 1669642948
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Entity Type | Organization
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Legal Business Name | THE GEORGIA CENTER FOR DERMATOLOGY AND SKIN CANCER SPECIALISTS
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Dates
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Enumeration Date | 03/03/2008
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Last Update Date | 03/03/2008
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Provider Practice Location Address
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Address Line | 902 PONDER PLACE CT
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City | EVANS
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State | GA
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Zip | 30809-3184
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Country | US
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Telephone | 706-364-8876
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Fax | 706-364-9061
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Provider Business Mailing Address
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Address Line | 902 PONDER PLACE CT
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City | EVANS
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State | GA
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Zip | 30809-3184
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Country | US
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Telephone | 706-364-8876
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Fax | 706-364-9061
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. STEPHEN H MASON
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Credential | M.D.
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Telephone | 706-364-8876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 059557
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License Number State | GA
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