Ace Pain and Spine LLC
Organization Active NPI Pain Clinic/Center · Dacula, GA
NPI 1811515554 · NPPES record last updated Jul 20, 2021
Key facts
- NPI
- 1811515554
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pain Clinic/Center 261QP3300X
- Legal business name
- ACE PAIN AND SPINE LLC
- Practice address
- 3625 Braselton Hwy Ste 201
Dacula, GA 30019-4695 - Phone
- (678) 404-2220
- NPI assigned
- Jul 9, 2020
- Organization subpart
- No
Authorized official
- Name
- Dr. Cory Mansour, MD
- Title
- Physician / Owner
- Phone
- (678) 889-2326
Practitioners 2
-
Cory Kane Mansour, M.D.
-
Andy Quoc Truong, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210208000064 | GA | Part B Supplier - Clinic/Group Practice | 0042624801 |
Receives reassigned benefits from 2 practitioners Practice locations: Dacula, GA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pain Clinic/Center | 261QP3300X | Yes |
Addresses
Primary practice location
3625 Braselton Hwy Ste 201
Dacula, GA 30019-4695
Mailing address
3625 Braselton Hwy Ste 201
Dacula, GA 30019-4695
Phone (678) 889-2326
Other providers in Dacula, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 20, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.