NPIMap

Organization Active NPI

Cornerstone Pediatrics LLC

  • Pediatrics Physician
  • Dacula, GA
National Provider Identifier
1295233211
Registry record updated Jan 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
043986 Issued in GA
Legal business name
CORNERSTONE PEDIATRICS LLC
Practice address
2700 Braselton Hwy Ste 1
Dacula, GA 30019-3207
Phone
(678) 543-9400
NPI assigned
Jan 24, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jennifer Cantrell, CPNPNPI 1902032915
Title
Owner
Phone
(404) 394-8001

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 043986 GA Primary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X RN166999 GA
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X RN170835 GA

Addresses

Primary practice location

2700 Braselton Hwy Ste 1
Dacula, GA 30019-3207

Mailing address

2700 Braselton Hwy Ste 1
Dacula, GA 30019-3207
Phone (678) 543-9400

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2141641Cornerstone Pediatrics2700 Braselton Highway, Suite 1, Dacula, GA 30019Certificate of waiverDec 18, 2027

National Provider Directory

National Provider Directory

Locations

2700 Braselton Hwy
Ste 1
Dacula, GA 30019
Phone (678) 543-9400

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1516752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516752000000",
    "number": "1295233211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 BRASELTON HWY STE 1",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300193207",
            "telephone_number": "678-543-9400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 BRASELTON HWY STE 1",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300193207",
            "telephone_number": "678-543-9400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNERSTONE PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-24",
        "last_updated": "2018-01-24",
        "status": "A",
        "authorized_official_last_name": "CANTRELL",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-394-8001",
        "authorized_official_credential": "CPNP"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "043986",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "RN166999",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "RN170835",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dacula, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.