Provider Demographics
NPI:1578821179
Name:CORNERSTONE MEDICAL CLINIC, PC
Entity Type:Organization
Organization Name:CORNERSTONE MEDICAL CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALEXNADER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-861-7081
Mailing Address - Street 1:1270 PRINCE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2762
Mailing Address - Country:US
Mailing Address - Phone:404-861-7081
Mailing Address - Fax:
Practice Address - Street 1:1270 PRINCE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2762
Practice Address - Country:US
Practice Address - Phone:404-861-7081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052417207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IO9375Medicare UPIN