Southeast Rehabilitation Corp

Primary specialty

Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X

Legal business name

SOUTHEAST REHABILITATION CORP

Practice address

3312 Northside Dr Ste A110
Macon, GA 31210-2520

Phone

(478) 477-2314

Fax

(478) 477-3599

NPI assigned

Aug 11, 2006

Organization subpart

No

Name

Victoria Mansour, MDNPI 1265444228

Title

Owner

Phone

(478) 477-2314

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Victoria T Mansour, MD

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Macon, GA
  • NPI 1265444228
  Medicare reassignment NPD Authorized official GA, Pain Medicine

Medicare fee-for-service enrollment

Enrolled in GA

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 20, 2007.

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195516800000",
    "number": "1093727067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3312 NORTHSIDE DR STE A110",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312102520",
            "telephone_number": "478-477-2314",
            "fax_number": "478-477-3599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3312 NORTHSIDE DR STE A110",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312102520",
            "telephone_number": "478-477-2314",
            "fax_number": "478-477-3599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST REHABILITATION CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-11",
        "last_updated": "2007-11-20",
        "status": "A",
        "authorized_official_last_name": "MANSOUR",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "478-477-2314",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sound Physicians Intensivists of Georgia PC
• Source Diagnostics of Georgia, LLC
• Source Diagnostics of Georgia, LLC
• South Macon Family Physicians Clinic
• Southeast Lung & Critical Care Specialists, PC
• Southeastern Surgery & Sleep Apnea Treatment Ctr. LLC
• Southeastern Surgical Oncology
• Southeastern Urology Associates
• Southern Anesthesia Consultants of Ga, LLC
• Southern Anesthesia Consultants, LLC

• All providers in Macon, GA
• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.