Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 2674 | GA |
N | 103T00000X | Psychologist | 2674 | GA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 2674 | GA |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 2674 | GA |
NPI | 1043382021 |
---|---|
Provider Name | Dr. Toni L Mason |
First Address | Bogart, GA 30622-2579 |
Second Address | Bogart, GA 30622-2579 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 20/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10034544 | AMERIGROUP (01) | GA |