Organization
SOUTHEAST REHABILITATION CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICTORIA MANSOUR MD (OWNER)
(478) 477-2314
Entity
Organization
Contact information
Practice address
3312 NORTHSIDE DR STE A110, MACON, GA 31210-2520
(478) 477-2314
(478) 477-3599
Mailing address
3312 NORTHSIDE DR STE A110, MACON, GA 31210-2520
(478) 477-2314
(478) 477-3599
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
—
Other
Enumeration date
08/11/2006
Last updated
11/20/2007
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