DR. CALIXTO JOSE CORNAVACA DIAZ (NPI# 1326381625) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326381625 |
| Entity Type | Individual |
| Full Name | DR. CALIXTO JOSE CORNAVACA DIAZ |
| Credential | M.D. |
| Practice Address |
578 S Enota Dr Ne Ste C Buford GA 30519-4392 |
| Mailing Address |
578 S Enota Dr Ne Ste C Gainesville GA 30501-8947 |
| Practice Telephone | 4236198381 |
| Practice Fax Number | 4702908474 |
| Mailing Telephone | 4708926607 |
| Mailing Fax Number | 4702908474 |
| Enumeration Date | 2013-04-04 |
| Last Update Date | 2019-03-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | 74951 | GA | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3615 Rolling Creek Dr, Buford, GA 305194392 | 4236198381 |
| Street Address |
578 S ENOTA DR NE STE C |
| City | BUFORD |
| State | GA |
| Zip Code | 30519-4392 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154880763 | Walter Kalenik | Physical Therapist | 3694 Lake Rabun Ct, Buford, GA 30519 | 2019-03-14 |
| 1083127500 | Bunmi Yemisi Folarinde | Nurse Practitioner | 3616 S Bogan Rd Ste 202, Buford, GA 30519 | 2017-11-06 |
| 1124546817 | Jenny Chang | Pharmacist | 2635 General Lee Way, Buford, GA 30519 | 2017-09-02 |
| 1588181853 | Vincent Spencer | Nurse Practitioner | 2128 Mill Garden Run, Buford, GA 30519 | 2017-08-27 |
| 1225567597 | Vincentia Paul-constantin | Clinic/Center | 2867 Country House Lane, Buford, GA 30519 | 2017-06-08 |
| 1043668361 | Jacob Matthew Minor | Chiropractor | 2725 Hamilton Rd, Ste 500, Buford, GA 30519 | 2016-05-26 |
| 1477910941 | Nicole Camp | Nurse Practitioner | 2725 Mall of Georgia Blvd, Buford, GA 30519 | 2016-01-28 |
| 1235519240 | Moyra Renee Betuzzi-teas | Obstetrics & Gynecology | 2527 Mall of Georgia Blvd, Buford, GA 30519 | 2015-06-04 |
| 1104250950 | Coyette Annisee Telemaque | Nurse Practitioner | 3331 Hamilton Mill Rd Ste 1102, Buford, GA 30519 | 2013-08-29 |
| 1649552134 | Indira Ashok Patel | Physical Medicine & Rehabilitation | 2839 Hidden Falls Drive, Buford, GA 30519 | 2011-09-12 |
| Find all providers in zip 30519 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497137194 | Marrc Medical Group | General Practice | 2952 Heart Pine Way, Buford, GA 30519-7639 | 2015-06-18 |
| 1003047184 | Home Physician Care, LLC | General Practice | 5012 Bristol Industrial Way, Suite 110, Buford, GA 30518-9050 | 2009-08-06 |
| 1700938123 | Hazim A Farisi | General Practice | 4965 Friendship Rd, St 103, Buford, GA 30518-1700 | 2007-01-17 |
| 1255609830 | Complete Healthcare of Buford | General Practice | 3280 Hamilton Mill Rd, Suite 304, Buford, GA 30519-7221 | 2011-12-09 |
| 1801078001 | Hazim A. Farisi Md PC | General Practice | 4965 Friendship Rd, Suite 103, Buford, GA 30518-1700 | 2007-11-29 |
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| 1053946004 | Proactive Medical Center | General Practice | 3455 Peachtree Industrial Blvd Ste 910, Duluth, GA 30096-6502 | 2020-03-10 |
| 1285265546 | Idea Body Institute Atlanta Asc | General Practice | 371 E Paces Ferry Rd Ne Ste 450, Atlanta, GA 30305-3292 | 2020-01-27 |
| 1730729849 | Summit Health Primary and Urgent Care LLC | General Practice | 120 Handley Rd Bldg 400 Ste #410, Tyrone, GA 30290-3029 | 2020-01-07 |
| 1770121030 | New Life Medical Centers Georgia LLC | General Practice | 3550 Lenox Rd Ne Ste 2100, Atlanta, GA 30326-1810 | 2019-12-18 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.