Cory Kane Mansour, M.D.
Individual provider Active NPI Pain Medicine (Anesthesiology) Physician · Dacula, GA
NPI 1871903567 · NPPES record last updated Jul 8, 2021
Key facts
- NPI
- 1871903567
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pain Medicine (Anesthesiology) Physician 207LP2900X
- License
- 81919 (GA)
- Practice address
- 3625 Braselton Hwy Ste 201
Dacula, GA 30019-4695 - Phone
- (678) 889-2326
- NPI assigned
- May 2, 2014
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Anesthesiology
- Education
- Medical College of Georgia School of Medicine, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Ace Pain and Spine LLC
Physiotherapy Associates Inc
Practice addresses (Care Compare)
3625 Braselton Hwy
Suite 201
Dacula, GA 30019-4695
Phone (678) 889-2326
966 A Killian Hill Rd SW
Lilburn, GA 30047-3102
Phone (770) 923-4815
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200114001992 | GA | Practitioner - Anesthesiology | 4183059447 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 81919 | GA | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Anesthesiologists for Dental Sedation LLC | Anesthesiology | Current | Accepting new patients |
| Mak Anesthesia Holdings LLC | Anesthesiology | Current |
Accepting new patients |
| Ace Pain and Spine LLC | Current |
Accepting new patients | |
| MH Dental PC | Past | Accepting new patients |
Locations
303 Parkway Dr NE
Atlanta, GA 30312
Phone (404) 265-4000
3950 Austell Rd
Austell, GA 30106
Phone (770) 732-3752
3625 Braselton Hwy
Ste 201
Dacula, GA 30019
Phone (678) 450-1222
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 81919 | GA | |
| Pain Medicine (Anesthesiology) Physician | 207LP2900X | 81919 | GA | Yes |
Addresses
Primary practice location
3625 Braselton Hwy Ste 201
Dacula, GA 30019-4695
Mailing address
1364 Clifton Rd NE # T5L38
Atlanta, GA 30322-1059
Other practice location 1
1364 Clifton Rd NE # T5L38
Atlanta, GA 30322
Phone (404) 778-4756
Other practice location 2
1364 Clifton Rd NE # T5L38
Atlanta, GA 30322
Phone (404) 778-4756
Other providers in Dacula, GA
- Manga Health Consultants, Dba / Regional
- Ebot B Manga
- Mangiarelli Rehabilitation of Georgia LLC
- Makayla Forrest Mangram
- Alicia Manley
- Stephanie L Marie
- Daniel Mariney
- Kayla Marshall
- Kenya Marthone
- Uyen DO Maschek
All providers in Dacula, GA · Pain Medicine (Anesthesiology) Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 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.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.