Organization
PREMIER CORNERSTONE MANAGEMENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TAWANNA O'PAL GORDON M.D. (OWNER)
(229) 894-7734
Entity
Organization
Contact information
Practice address
66 PARKER ST, REYNOLDS, GA 31076-2943
(478) 847-4690
Mailing address
PO BOX 272, REYNOLDS, GA 31076-0272
(478) 847-4690
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
0101244776
VA
207V00000X
Obstetrics & Gynecology Physician
055753
GA
207V00000X
Obstetrics & Gynecology Physician
MD424859
PA
Other
Enumeration date
01/25/2010
Last updated
07/29/2010
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