Healthcare Provider Details

I. General information

NPI: 1396033528
Provider Name (Legal Business Name): CORNERSTONE MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3631 EXPLORER TRL SUITE A
OAKWOOD GA
30566-2816
US

IV. Provider business mailing address

PO BOX 76850
ATLANTA GA
30358-1850
US

V. Phone/Fax

Practice location:
  • Phone: 770-399-7337
  • Fax: 770-392-4771
Mailing address:
  • Phone: 770-399-7337
  • Fax: 770-392-4771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ANDREW P. SIMMONS SR.
Title or Position: PRESIDENT/CEO
Credential:
Phone: 770-399-7337