| Cornavaca Clinic | |
|
578 S Enota Dr Ne Ste C Gainesville GA 30501-8947 | |
| (470) 892-6607 | |
| (470) 290-8474 |
| Full Name | Cornavaca Clinic |
|---|---|
| Speciality | General Practice |
| Location | 578 S Enota Dr Ne Ste C, Gainesville, Georgia |
| Authorized Official Name and Position | Spring Cornavaca (BUSINESS ADMINISTRATOR) |
| Authorized Official Contact | 4708926607 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cornavaca Clinic 578 S Enota Dr Ne Ste C Gainesville GA 30501-8947 Ph: (470) 892-6607 | Cornavaca Clinic 578 S Enota Dr Ne Ste C Gainesville GA 30501-8947 Ph: (470) 892-6607 |
| NPI Number | 1487140349 |
|---|---|
| Provider Enumeration Date | 07/03/2018 |
| Last Update Date | 07/03/2018 |
| Medicare PECOS PAC ID | 2961756432 |
|---|---|
| Medicare Enrollment ID | O20181120000757 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487140349 | NPI | - | NPPES |
| 1417990334 | Medicaid | GA | |
| 1326381625 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 028490 (Georgia) | Secondary |
| 208D00000X | General Practice | 74951 (Georgia) | Primary |
| Provider Name | Melanie L Cooper |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669427316 PECOS PAC ID: 2961434964 Enrollment ID: I20050909000562 |
| Provider Name | Calixto J Cornavaca Diaz |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1326381625 PECOS PAC ID: 7517100803 Enrollment ID: I20181120000668 |
William T. Jones, M.d.,pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1098 S Enota Dr Ne, Gainesville, GA 30501 Phone: 770-532-4517 Fax: 770-503-0267 | |
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