Provider Demographics
NPI:1407825359
Name:TREBONY, MASON TODD (MD)
Entity Type:Individual
Prefix:DR
First Name:MASON
Middle Name:TODD
Last Name:TREBONY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 S UNDERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:CAMILLY
Mailing Address - State:GA
Mailing Address - Zip Code:31730
Mailing Address - Country:US
Mailing Address - Phone:229-454-5964
Mailing Address - Fax:
Practice Address - Street 1:9 HOSPITAL PARK
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-6772
Practice Address - Country:US
Practice Address - Phone:229-890-1442
Practice Address - Fax:229-890-0782
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040804207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11D0942926OtherCLIA
GA52670227OtherBC/BS OF GA
GA331639OtherWELLCARE
GA000752375AMedicaid
GA040804OtherGA LICENSE
GA110149299OtherRR MEDICARE/METRAHEALTH
GA040804OtherGA LICENSE
GA11D0942926OtherCLIA