MEDICARE: SARAH JOANNA MASON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant		MS

General Provider Information

NPI Number	:	1093172157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH JOANNA MASON PA-C

Provider Business Mailing Address
First Line	:	965 RIDGE LAKE BLVD STE 103
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38120-9446
Country	:	US
Telephone Number	:	901-227-3255
Fax Number	:	901-227-8591

Provider Business Practice Location Address
First Line	:	7275 S SIWELL RD
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39272-9776
Country	:	US
Telephone Number	:	601-373-7722
Fax Number	:	601-373-7128

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2016
Last Update Date	:	03/17/2018

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