Healthcare Provider Details

I. General information

NPI: 1720103609
Provider Name (Legal Business Name): CORNERSTONE HEALTH CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 11/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 PREMIER DRIVE SUITE 201
HIGH POINT NC
27265-8350
US

IV. Provider business mailing address

1701 WESTCHESTER DRIVE SUITE 850
HIGH POINT NC
27262-7254
US

V. Phone/Fax

Practice location:
  • Phone: 336-802-2222
  • Fax: 336-802-2351
Mailing address:
  • Phone: 336-802-2536
  • Fax: 336-802-2534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GRACE E TERRELL
Title or Position: PRESIDENT / CEO
Credential: MD
Phone: 336-802-2400