Organization
DECATUR FAMILY MEDICAL GROUP INC
Active
Other names
Cornerstone Family Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID CARL GREGORY M.D. (CEO)
(217) 422-3702
Entity
Organization
Contact information
Practice address
440 SUNSET CT STE C, MT ZION, IL 62549-1556
(217) 864-1236
(217) 864-1470
Mailing address
3708 SIMS DR, DECATUR, IL 62526-9200
(217) 422-3702
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
036103155
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1871599522
PROVIDER'S NPI
—
Enumeration date
03/30/2012
Last updated
07/21/2022
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