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Contact Information

CALIXTO J CORNAVACA DIAZ MD LLC
578 S ENOTA DR NE STE C
GAINESVILLE, GA30501-8947
 Phone: 470-892-6607
 Fax: 470-290-8474
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

General Practice

208D00000X 99 Physician/Undefined Physician type[6]
 

Internal Medicine

207R00000X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for CALIXTO J CORNAVACA DIAZ MD LLC · (Female)

NPI Number 1487140349
Status Active
Credentials
Entity Individual
Enumeration date 07/03/2018
Last updated 07/03/2018 - About 8 years ago
Sole proprietor 1 Not specified
Identifiers
  • GA License # 028490
  • GA License # 74951
  • GA Medicaid 1417990334
  • TN Medicaid 1326381625
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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