Cornavaca Clinic
LBN: Calixto J Cornavaca Diaz Md Llc
Cornavaca Clinic is an health care organization with primary practice located at 578 S Enota Dr Ne Ste C , Gainesville GA 30501-8947. The organization recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / General Practice. Allopathic & Osteopathic Physicians / General Practice is the primary health care specialty.
Calixto J Cornavaca Diaz Md Llc can be contacted via phone (470) 892-6607, or through Cornavaca, Spring via phone (470) 892-6607.
Contact Information
Primary practice address
578 S Enota Dr Ne Ste C
Gainesville GA 30501-8947
Phone: (470) 892-6607
Fax: (470) 290-8474
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 028490 | Georgia |
| Allopathic & Osteopathic Physicians / General Practice | 208D00000X | 74951 | Georgia |
Profile Details
| NPI number | 1487140349 |
|---|---|
| LBN Legal business name | Calixto J Cornavaca Diaz Md Llc |
| DBA Doing business as | Cornavaca Clinic |
| Authorized official | Cornavaca, Spring |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Jul 3rd, 2018 |
| Last updated | Jul 3rd, 2018 - about 6 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1487140349 | NPPES |
| Georgia | MEDICAID | 1417990334 | |
| Georgia | MEDICAID | 1326381625 |
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