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Organization
CALIXTO J CORNAVACA DIAZ MD LLC
Active
Organization
CALIXTO J CORNAVACA DIAZ MD LLC
Active
Other names
Cornavaca Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SPRING CORNAVACA (BUSINESS ADMINISTRATOR)
(470) 892-6607
Entity
Organization
Contact information
Practice address
578 S ENOTA DR NE STE C, GAINESVILLE, GA 30501-8947
(470) 892-6607
(470) 290-8474
Mailing address
578 S ENOTA DR NE STE C, GAINESVILLE, GA 30501-8947
(470) 892-6607
(470) 290-8474
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
028490
GA
208D00000X
General Practice Physician
Primary
74951
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1326381625
—
TN
05
—
1417990334
—
GA
Enumeration date
07/03/2018
Last updated
07/03/2018
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