11D2157968 CLIA NUMBER - CORNAVACA CLINIC

Laboratory Demographics

  • CLIA Code: 11D2157968
  • Facility Name: CORNAVACA CLINIC
  • Facility Address: 578 SOTH ENOTA DRIVE, SUITE C
    GAINESVILLE, GA
    ZIP 30501
  • Facility Phone: 470 892-6607
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CALIXTO J. CORNAVACA DIAZ
  • NPI Number: 1487140349
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 11D2157968
LAB Type Physician Office
Facility Name CORNAVACA CLINIC
Street 578 SOTH ENOTA DRIVE, SUITE C
City GAINESVILLE
State GA
ZIP 30501
Phone 470 892-6607
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/19/2024
Certificate Expiration Date 11/18/2026
Facility Type Physician Office
Lab Director CALIXTO J. CORNAVACA DIAZ

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This page was last updated on: 9/29/2025