Mason Primary Care Clinic, LP

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

MASON PRIMARY CARE CLINIC, LP

Practice address

3500 McClure Bridge Rd
Duluth, GA 30096-3131

Phone

(770) 476-3636

Fax

(770) 476-5845

NPI assigned

May 10, 2006

Last updated

Jan 13, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Missy Martin

Title

Billing Manager

Phone

(770) 622-3114

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Mason Primary Care Other name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263340800000",
    "number": "1952351116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 248",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300960005",
            "telephone_number": "770-476-3636",
            "fax_number": "770-476-5845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 MCCLURE BRIDGE RD",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300963131",
            "telephone_number": "770-476-3636",
            "fax_number": "770-476-5845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASON PRIMARY CARE CLINIC, LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2010-01-13",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "MISSY",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "770-622-3114"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "055002346A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000364339S",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000817363D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mason Primary Care",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Gary S. Martin, DC
• Brian Daniel Martinez-Torres, DC
• Nathan Mascaro, PH.D.
• Rosemarie Masci-Yarus, M.S. ED., BCBA, LBA
• Mason Home Care LLC
• Ebony Mason
• Grace Elizabeth Mason, FNP-C
• Miles H Mason III, MD
• Lena Cynthia Masopust, OD
• Patricia Beatriz Masso Maldonado, AUD

• Internal Medicine Physician in Duluth, GA
• Providers in Duluth, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.