| Doctor Name: | DR. CALIXTO JOSE CORNAVACA DIAZ |
| NPI Number: | 1326381625 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 74951 |
| Business Practice Address: | 6300 Jimmy Carter Blvd Ste 110 Norcross, GA - 300712347 |
| Business Phone Number: | 7702801919 |
| Business Fax Number: | |
| Mailing Address: | 6300 Jimmy Carter Blvd Ste 110, NORCROSS |
| State: | GA |
| Postal Code: | 300712347 |
| Phone Number: | 7702801919 |
| Fax Number: | |
| NPI Enumeration Date: | 04/04/2013 |
| NPI Last Update Date: | 02/01/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 74951 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |