Provider Demographics
NPI:1992878227
Name:KORNMAYER, JOHN D (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:KORNMAYER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NC
Mailing Address - Zip Code:28722-0608
Mailing Address - Country:US
Mailing Address - Phone:828-894-8213
Mailing Address - Fax:828-894-5775
Practice Address - Street 1:45 E MILLS ST.
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NC
Practice Address - Zip Code:28722
Practice Address - Country:US
Practice Address - Phone:828-894-8213
Practice Address - Fax:828-894-5775
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800939207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891155AMedicaid
NC891155AMedicaid
NCG73541Medicare UPIN