Provider Demographics
NPI:1467266106
Name:CORNERSTONE MENTAL HEALTH CENTER LLC
Entity type:Organization
Organization Name:CORNERSTONE MENTAL HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLABISI
Authorized Official - Middle Name:
Authorized Official - Last Name:FAFORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-227-4763
Mailing Address - Street 1:1183 LANIER SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-7272
Mailing Address - Country:US
Mailing Address - Phone:612-227-4763
Mailing Address - Fax:
Practice Address - Street 1:11340 LAKEFIELD DR STE 200
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-2456
Practice Address - Country:US
Practice Address - Phone:612-227-4763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty