Provider Demographics
NPI:1861149270
Name:MASON, BEVERLY (FNP)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:GA
Mailing Address - Zip Code:30206-3140
Mailing Address - Country:US
Mailing Address - Phone:404-747-1234
Mailing Address - Fax:
Practice Address - Street 1:78 INDIAN TRL
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:GA
Practice Address - Zip Code:30206-3140
Practice Address - Country:US
Practice Address - Phone:404-747-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-05
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF01220539363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily