MEDICARE: CORY MACK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant	5668	GA

General Provider Information

NPI Number	:	1578411799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORY MACK

Provider Business Mailing Address
First Line	:	1921 BROWNING BEND CT
Second Line	:
City	:	DACULA
State	:	GA
Zip	:	30019-7774
Country	:	US
Telephone Number	:	404-655-9789
Fax Number	:

Provider Business Practice Location Address
First Line	:	1921 BROWNING BEND CT
Second Line	:
City	:	DACULA
State	:	GA
Zip	:	30019-7774
Country	:	US
Telephone Number	:	404-655-9789
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2026
Last Update Date	:	03/21/2026

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Directions to “ CORY MACK ” Practice Location

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