Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 61122 | TN |
N | 207K00000X | Allergist & Immunologist | 85855 | GA |
N | 208000000X | Pediatrician | 61122 | TN |
N | 208000000X | Pediatrician | 85855 | GA |
NPI | 1225422280 |
---|---|
Provider Name | Jessica Sebastian Van Mason |
First Address | Chattanooga, TN 37421-2423 |
Second Address | Chattanooga, TN 37421-2423 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2015 |
Last Update Date | 21/12/2020 |