Provider Demographics
NPI:1548097017
Name:KORNERSTONE ENTITIES OF GA
Entity type:Organization
Organization Name:KORNERSTONE ENTITIES OF GA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-593-1672
Mailing Address - Street 1:2274 SALEM RD SE STE 106-1419
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2097
Mailing Address - Country:US
Mailing Address - Phone:678-912-1248
Mailing Address - Fax:
Practice Address - Street 1:2274 SALEM RD SE STE 106-1419
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2097
Practice Address - Country:US
Practice Address - Phone:678-912-1248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)