Healthcare Provider Details

I. General information

NPI: 1992309389
Provider Name (Legal Business Name): CORNERSTONE PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 03/07/2023
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 CLEAR SKY CT STE C
CLARKSVILLE TN
37043-5685
US

IV. Provider business mailing address

298 CLEAR SKY CT STE C
CLARKSVILLE TN
37043-5685
US

V. Phone/Fax

Practice location:
  • Phone: 931-444-9158
  • Fax: 931-538-4673
Mailing address:
  • Phone: 931-444-9158
  • Fax: 931-538-4673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHY GRIFFIETH
Title or Position: OFFICE MANAGER-RN
Credential: REGISTERED NURSE
Phone: 931-444-9158