Provider Demographics
NPI:1255392148
Name:MASON, TINA MARIE (MD)
Entity type:Individual
Prefix:MISS
First Name:TINA
Middle Name:MARIE
Last Name:MASON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6300 HOSPITAL PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1828
Mailing Address - Country:US
Mailing Address - Phone:678-985-5800
Mailing Address - Fax:678-376-5848
Practice Address - Street 1:6300 HOSPITAL PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1828
Practice Address - Country:US
Practice Address - Phone:678-985-5800
Practice Address - Fax:678-376-5848
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039405207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G36916Medicare UPIN
GA16BBCBFMedicare ID - Type Unspecified