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General NPI Number Information
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NPI Number | 1962809285
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Entity Type | Organization
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Legal Business Name | CORNERSTONE SURGERY OF BRASELTON, PC
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Dates
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Enumeration Date | 12/02/2014
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Last Update Date | 10/09/2015
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Provider Practice Location Address
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Address Line | 1404 RIVER PL STE 201B
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City | BRASELTON
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State | GA
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Zip | 30517-5600
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Country | US
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Telephone | 770-307-4762
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Fax |
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Provider Business Mailing Address
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Address Line | 1404 RIVER PL STE 201B
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City | BRASELTON
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State | GA
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Zip | 30517-5600
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Country | US
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Telephone | 770-848-9390
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Fax | 770-848-9391
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Authorized Official
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Title or Position | PRESIDENT
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Name | J. CHRISTOPHER BRANDYS
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Credential | MD
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Telephone | 770-848-9390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 053639
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License Number State | GA
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