MEDICARE: RUDOLPH AMADEUS MASON M.D.

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	207Q00000X	Family Medicine Physician	54615	GA
2	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	054615	GA
3	363A00000X	Physician Assistant	54615	GA
4	207QS0010X	Sports Medicine (Family Medicine) Physician	54615	GA

General Provider Information

NPI Number	:	1295851087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUDOLPH AMADEUS MASON M.D.

Provider Business Mailing Address
First Line	:	5080 SPECTRUM DRIVE
Second Line	:	SUITE 1200 WEST TOWER
City	:	ADDISON
State	:	TX
Zip	:	75001
Country	:	US
Telephone Number	:	800-232-3550
Fax Number	:

Provider Business Practice Location Address
First Line	:	860 DULUTH HWY
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043-5326
Country	:	US
Telephone Number	:	972-725-6673
Fax Number	:

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	06/15/2026

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