Provider Demographics
NPI:1063644789
Name:MASON, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MASON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 BAUM DR
Mailing Address - Street 2:BUILDING 1
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-7315
Mailing Address - Country:US
Mailing Address - Phone:865-374-7100
Mailing Address - Fax:
Practice Address - Street 1:423 MEDICAL PARK DR
Practice Address - Street 2:SUITE 400
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-5640
Practice Address - Country:US
Practice Address - Phone:865-374-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health