Provider Demographics
NPI:1962809285
Name:CORNERSTONE SURGERY OF BRASELTON, PC
Entity type:Organization
Organization Name:CORNERSTONE SURGERY OF BRASELTON, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:J. CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDYS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-848-9390
Mailing Address - Street 1:1404 RIVER PL
Mailing Address - Street 2:STE 201B
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-5600
Mailing Address - Country:US
Mailing Address - Phone:770-848-9390
Mailing Address - Fax:770-848-9391
Practice Address - Street 1:1404 RIVER PL
Practice Address - Street 2:STE 201B
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-5600
Practice Address - Country:US
Practice Address - Phone:770-307-4762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-02
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053639208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty