Individual
DR. MILES H MASON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3500 MCCLURE BRIDGE ROAD, DULUTH, GA 30096
(770) 476-3021
(770) 476-5845
Mailing address
PO BOX 849, DULUTH, GA 30096
(770) 476-3021
(770) 476-5845
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
15399
GA
208600000X
Surgery Physician
Primary
15399
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000178318A
—
GA
01
—
4031159
AETNA
GA
Enumeration date
09/26/2006
Last updated
11/25/2009
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