Provider Demographics
NPI:1215112321
Name:TINA M. MASON, M.D., L.L.C.
Entity type:Organization
Organization Name:TINA M. MASON, M.D., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARETTE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-985-5800
Mailing Address - Street 1:935 RIVER CENTRE PL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-7322
Mailing Address - Country:US
Mailing Address - Phone:678-985-5800
Mailing Address - Fax:
Practice Address - Street 1:935 RIVER CENTRE PL
Practice Address - Street 2:SUITE 200
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-7322
Practice Address - Country:US
Practice Address - Phone:678-985-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039405173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG36916Medicare UPIN