Provider Demographics
NPI:1154497113
Name:CORNERSTONE MEDICAL INC
Entity Type:Organization
Organization Name:CORNERSTONE MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:P
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:770-399-7337
Mailing Address - Street 1:PO BOX 76850
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30358-1850
Mailing Address - Country:US
Mailing Address - Phone:770-399-7337
Mailing Address - Fax:770-392-4771
Practice Address - Street 1:995 MANSELL RD
Practice Address - Street 2:SUITE D
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1505
Practice Address - Country:US
Practice Address - Phone:770-399-7335
Practice Address - Fax:770-392-4771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0525630001Medicare ID - Type Unspecified