Individual
DR. MASON TODD TREBONY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9 HOSPITAL PARK, MOULTRIE, GA 31768-6772
(229) 890-1442
(229) 890-0782
Mailing address
9 S UNDERWOOD ST, CAMILLY, GA 31730
(229) 454-5964
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
040804
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000752375A
—
GA
01
—
040804
GA LICENSE
GA
01
—
110149299
RR MEDICARE/METRAHEALTH
GA
01
—
11D0942926
CLIA
GA
01
—
331639
WELLCARE
GA
01
—
52670227
BC/BS OF GA
GA
Enumeration date
03/14/2006
Last updated
08/01/2023
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