Provider Demographics
NPI:1083087837
Name:CORNERSTONE FAMILY PRACTICE & URGENT CARE, PLLC
Entity Type:Organization
Organization Name:CORNERSTONE FAMILY PRACTICE & URGENT CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:910-307-1576
Mailing Address - Street 1:PO BOX 2376
Mailing Address - Street 2:
Mailing Address - City:BRYSON CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28713-2376
Mailing Address - Country:US
Mailing Address - Phone:910-302-3801
Mailing Address - Fax:828-538-4441
Practice Address - Street 1:1536 OWEN PARK LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3454
Practice Address - Country:US
Practice Address - Phone:910-307-1576
Practice Address - Fax:910-500-3117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCF766OtherMEDICARE