Basic Information
| Provider Information | |||||||||
| NPI: | 1205281318 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CORNERSTONE MEDICAL CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 743897 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303743897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708745400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 GROSS CRESCENT CIR | ||||||||
| Address2: | |||||||||
| City: | FORT OGLETHORPE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307423643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068582000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2016 | ||||||||
| LastUpdateDate: | 04/26/2016 | ||||||||
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| AuthorizedOfficialLastName: | ROBINSON | ||||||||
| AuthorizedOfficialFirstName: | ALLEN | ||||||||
| AuthorizedOfficialMiddleName: | J. B. | ||||||||
| AuthorizedOfficialTitleorPosition: | ACTING CEO | ||||||||
| AuthorizedOfficialTelephone: | 7708745400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | GA | Y | Hospitals | General Acute Care Hospital |
No ID Information.