Provider Demographics
NPI:1720285398
Name:FLORENCE, MASON NEAL (MD)
Entity Type:Individual
Prefix:DR
First Name:MASON
Middle Name:NEAL
Last Name:FLORENCE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1765 OLD WEST BROAD ST BLDG 2-200
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2887
Mailing Address - Country:US
Mailing Address - Phone:706-549-1663
Mailing Address - Fax:706-546-8792
Practice Address - Street 1:1765 OLD WEST BROAD ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2853
Practice Address - Country:US
Practice Address - Phone:706-549-1663
Practice Address - Fax:706-546-8792
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2024-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA69809207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
12582027OtherCAQH NUMBER
GA003142033AMedicaid
GA202I208560Medicare PIN