# PREMIER CORNERSTONE MANAGEMENT, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992036396
- **Authorized official:** DR. TAWANNA O'PAL GORDON M.D. (OWNER)
- **Authorized official phone:** (229) 894-7734

## Contact information

- **Practice address:** 66 PARKER ST, REYNOLDS, GA 31076-2943
- **Practice address phone:** (478) 847-4690
- **Mailing address:** PO BOX 272, REYNOLDS, GA 31076-0272
- **Mailing address phone:** (478) 847-4690

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 0101244776 | VA | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | 055753 | GA | — |
| 207V00000X | Obstetrics & Gynecology Physician | MD424859 | PA | — |

## Other

- **Enumeration date:** 01/25/2010
- **Last updated:** 07/29/2010