Provider Demographics
NPI:1811515554
Name:ACE PAIN AND SPINE LLC
Entity type:Organization
Organization Name:ACE PAIN AND SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-889-2326
Mailing Address - Street 1:3625 BRASELTON HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-4695
Mailing Address - Country:US
Mailing Address - Phone:678-889-2326
Mailing Address - Fax:470-238-3658
Practice Address - Street 1:3625 BRASELTON HWY STE 201
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-4695
Practice Address - Country:US
Practice Address - Phone:678-404-2220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-09
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain