Provider Demographics
NPI:1457441354
Name:CORNUM, RHONDA (MD)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:CORNUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1273 STAFF ROW SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-5124
Mailing Address - Country:US
Mailing Address - Phone:404-464-7394
Mailing Address - Fax:404-464-7512
Practice Address - Street 1:1273 STAFF ROW SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-5124
Practice Address - Country:US
Practice Address - Phone:404-464-7394
Practice Address - Fax:404-464-7512
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00013973208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology