Provider Demographics
NPI:1477703221
Name:MASON, ANGELIA ANDERSON (NP-C)
Entity Type:Individual
Prefix:MS
First Name:ANGELIA
Middle Name:ANDERSON
Last Name:MASON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:A
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:231 W. HANCOCK STREET
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061
Mailing Address - Country:US
Mailing Address - Phone:478-445-5288
Mailing Address - Fax:478-445-3142
Practice Address - Street 1:231 W. HANCOCK STREET
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061
Practice Address - Country:US
Practice Address - Phone:478-445-5288
Practice Address - Fax:478-445-3142
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN089586363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner