Provider Demographics
NPI:1093940264
Name:CORNER MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:CORNER MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:W
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:706-695-0446
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:430 NORTH 3RD AVE
Mailing Address - City:CHATSWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30705-0099
Mailing Address - Country:US
Mailing Address - Phone:706-695-0446
Mailing Address - Fax:706-517-5157
Practice Address - Street 1:430 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-2540
Practice Address - Country:US
Practice Address - Phone:706-695-0446
Practice Address - Fax:706-517-5157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care