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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

NPI Number 1487140349
LBN Legal business name CALIXTO J CORNAVACA DIAZ MD LLC
Authorized official SPRING CORNAVACA - (BUSINESS ADMINISTRATOR)
Entity Organization
Organization subpart 1 No
Enumeration date 07/03/2018
Last updated 07/03/2018 - About 8 years ago
Identifiers
GA License # 028490
GA License # 74951
GA Medicaid 1417990334
TN Medicaid 1326381625
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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