National Provider Identifier Database

CALIXTO J CORNAVACA DIAZ MD LLC
General Practice

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.


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
* General Practice 208D00000X
Internal Medicine 207R00000X

* Indicates primary specialty

NPI Profile & details for CALIXTO J CORNAVACA DIAZ MD LLC

NPI Number 1487140349
Legal business name
LBN
CALIXTO J CORNAVACA DIAZ MD LLC
Authorized official SPRING CORNAVACA - (BUSINESS ADMINISTRATOR)
Entity Organization
Organization subpart No
Enumeration date 07/03/2018
Last updated 07/03/2018 - About 8 years ago
Sole proprietor1 Not specified
Identifiers
  • GA License #: 028490
  • GA License #: 74951
  • GA Medicaid: 1417990334
  • TN Medicaid: 1326381625

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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