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

Last updated

Nov 20, 2007By 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

Victoria Mansour, MDNPI 1265444228

Title

Owner

Phone

(478) 477-2314

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Victoria T Mansour, MD

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

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

{
    "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 (Southeast Lung Associates)
• Southeastern Surgery & Sleep Apnea Treatment Ctr. LLC
• Southeastern Surgical Oncology
• Southeastern Urology Associates
• Southern Anesthesia Consultants of Ga, LLC
• Southern Anesthesia Consultants, LLC

• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Macon, GA
• Providers in Macon, GA by specialty
• 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.