Active NPI
Mason Dean Worsham, DPT
- Physical Therapist
- Camilla, GA
National Provider Identifier
1841738309
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 130 E Broad St
Camilla, GA 31730-1809 - Phone
- (229) 336-1115
- Fax
- (229) 336-1151
- NPI assigned
- Feb 5, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | GA | ||
| Physical Therapist | 225100000X | Primary |
Addresses
Primary practice location
130 E Broad St
Camilla, GA 31730-1809
Mailing address
130 E Broad St
Camilla, GA 31730-1809
Phone (229) 336-1115
Other practice location 1
109 Court Dr
Camilla, GA 31730-2313
Phone (229) 894-7293
Other practice location 2
1366 US Highway 82 W
Leesburg, GA 31763-5810
Phone (229) 883-4009
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660003200000",
"number": "1841738309",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 E BROAD ST",
"city": "CAMILLA",
"state": "GA",
"postal_code": "317301809",
"telephone_number": "229-336-1115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 E BROAD ST",
"city": "CAMILLA",
"state": "GA",
"postal_code": "317301809",
"telephone_number": "229-336-1115",
"fax_number": "229-336-1151"
}
],
"practiceLocations": [
{
"address_1": "109 Court Dr",
"address_purpose": "LOCATION",
"city": "Camilla",
"state": "GA",
"postal_code": "317302313",
"country_code": "US",
"telephone_number": "229-894-7293",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1366 US Highway 82 W",
"address_purpose": "LOCATION",
"city": "Leesburg",
"state": "GA",
"postal_code": "317635810",
"country_code": "US",
"telephone_number": "229-883-4009",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WORSHAM",
"first_name": "MASON",
"middle_name": "DEAN",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-02-05",
"last_updated": "2022-08-09",
"certification_date": "2022-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "GA",
"license": null,
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Camilla, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.