Provider Demographics
NPI:1790250199
Name:MASON, JAMES CURTIS JR
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CURTIS
Last Name:MASON
Suffix:JR
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 1:687 HAZELTON DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-7390
Mailing Address - Country:US
Mailing Address - Phone:601-624-1329
Mailing Address - Fax:
Practice Address - Street 1:687 HAZELTON DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-7390
Practice Address - Country:US
Practice Address - Phone:601-624-1329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS802118088172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver