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CORNAVACA CLINIC
NPI 1487140349
General Practice in Gainesville, GA

Active since July 03, 2018CLIA 11D2157968 · Waiver
578 S ENOTA DR NE STE C, GAINESVILLE, GA 30501(470) 892-6607(470) 290-8474 Get Directions Write a Review

NPPES record last updated: July 3, 2018. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Cornavaca Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CORNAVACA CLINIC (NPI 1487140349) is a healthcare organization registered as a general practice in Gainesville, Georgia and active in the NPI registry since July 2018. The organization holds a CLIA Waiver certificate valid through November 18, 2026 and lists Spring Cornavaca, Business Administrator, as its authorized official.

NPPES Registry Identity

NPI1487140349
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameCALIXTO J CORNAVACA DIAZ MD LLC
Location Address578 S ENOTA DR NE STE CGainesville, GA 30501-8947
Mailing Address578 S Enota Dr Ne Ste CGainesville, GA 30501-8947 · (470) 892-6607 · Fax (470) 290-8474
Phone(470) 892-6607
Fax(470) 290-8474
Organization SubpartNo
Authorized OfficialSpring CornavacaBusiness Administrator · (470) 892-6607
Enumeration DateJuly 3, 2018
✔ NPI 1487140349 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
License✔ Licensed in GA · 74951
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
Also ListedInternal MedicineTaxonomy 207R00000X · License 028490 (GA)
578 S ENOTA DR NE STE C, Gainesville, GA 30501
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Other Names 1

Doing Business AsCornavaca Clinic

Other Identifiers 2

Medicaid1326381625TN
Medicaid1417990334GA

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D2157968

Cornavaca Clinic · Gainesville, GA
Active · expires Nov 18, 2026
CLIA Number11D2157968
Laboratory TypePhysician Office
Certificate Effective DateNovember 19, 2024
Certificate Expiration DateNovember 18, 2026
Laboratory DirectorCalixto J. Cornavaca Diaz
Laboratory Phone(470) 892-6607
Laboratory LocationCornavaca Clinic578 Soth Enota Drive, Suite C, Gainesville, GA 30501
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. MELANIE L COOPER M.D.
Family Medicine
578 S ENOTA DR NE STE C
GAINESVILLE, GA 30501
Hall County (470) 290-8474

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Calixto J Cornavaca Diaz MD LLC's NPI number?

The NPI number for Calixto J Cornavaca Diaz MD LLC is 1487140349. It was assigned to this organization in the NPPES registry on July 3, 2018. The provider is doing business as Cornavaca Clinic.

Where is Calixto J Cornavaca Diaz MD LLC located?

Calixto J Cornavaca Diaz MD LLC is located at 578 S Enota Dr NE Ste C, Gainesville, GA 30501. The listed phone number is (470) 892-6607.

What is Calixto J Cornavaca Diaz MD LLC's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Does Calixto J Cornavaca Diaz MD LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2157968) is associated with this NPI, valid through November 18, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Calixto J Cornavaca Diaz MD LLC was last updated on July 3, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.