Provider Demographics
NPI:1659551091
Name:CORNERSTONE FAMILY PRACTICE, P.C.
Entity Type:Organization
Organization Name:CORNERSTONE FAMILY PRACTICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-904-2112
Mailing Address - Street 1:2098 TERON TRCE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-1663
Mailing Address - Country:US
Mailing Address - Phone:770-904-2112
Mailing Address - Fax:678-546-3687
Practice Address - Street 1:2098 TERON TRCE
Practice Address - Street 2:SUITE 400
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1663
Practice Address - Country:US
Practice Address - Phone:770-904-2112
Practice Address - Fax:678-546-3687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043107174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA08BBQMHOtherMEDICARE PROVIDER ID