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General NPI Number Information
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NPI Number | 1417501834
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Entity Type | Organization
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Legal Business Name | CORNERSTONE HOSPICE AND PALLIATIVE CARE OF GEORGIA, LLC
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Dates
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Enumeration Date | 07/25/2019
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Last Update Date | 03/30/2020
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Provider Practice Location Address
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Address Line | 1225 JOHNSON FERRY RD., BLDG. 100, SUITE 160
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City | MARIETTA
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State | GA
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Zip | 30068
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Country | US
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Telephone | 678-402-0005
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Fax |
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Provider Business Mailing Address
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Address Line | 2445 LANE PARK RD
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City | TAVARES
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State | FL
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Zip | 32778-9648
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Country | US
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Telephone | 352-343-1341
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Fax | 352-343-6115
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. CHARLES O. LEE
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Credential |
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Telephone | 352-343-1341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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