Healthcare Provider Details

I. General information

NPI: 1881006658
Provider Name (Legal Business Name): CORNERSTONE ANESTHESIA GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2014
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1559 SPARTA ST
MCMINNVILLE TN
37110-1316
US

IV. Provider business mailing address

PO BOX 293299
NASHVILLE TN
37229-3299
US

V. Phone/Fax

Practice location:
  • Phone: 913-815-4210
  • Fax:
Mailing address:
  • Phone: 615-620-2320
  • Fax: 615-620-2323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL S STOVALL
Title or Position: MBR
Credential: CRNA
Phone: 931-510-9097