Provider Demographics
NPI:1336981190
Name:MASON, DANIELLE (RN)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2578 MILL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HIAWASSEE
Mailing Address - State:GA
Mailing Address - Zip Code:30546-5117
Mailing Address - Country:US
Mailing Address - Phone:386-503-9460
Mailing Address - Fax:
Practice Address - Street 1:2578 MILL CREEK RD
Practice Address - Street 2:
Practice Address - City:HIAWASSEE
Practice Address - State:GA
Practice Address - Zip Code:30546-5117
Practice Address - Country:US
Practice Address - Phone:386-503-9460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN324145171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator