Organization
MASON PRIMARY CARE CLINIC, LP
Active
Other names
Mason Primary Care
Organization subpart
No
Provider details
NPI number
Authorized official
MISSY MARTIN (BILLING MANAGER)
(770) 622-3114
Entity
Organization
Contact information
Practice address
3500 MCCLURE BRIDGE RD, DULUTH, GA 30096-3131
(770) 476-3636
(770) 476-5845
Mailing address
PO BOX 248, DULUTH, GA 30096-0005
(770) 476-3636
(770) 476-5845
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000364339S
—
GA
05
—
000817363D
—
GA
05
—
055002346A
—
GA
Enumeration date
05/10/2006
Last updated
01/13/2010
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