Healthcare Provider Details

I. General information

NPI: 1417886706
Provider Name (Legal Business Name): ABHINAV NIMMAGADDA EMT-B
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 AUSTELL RD
AUSTELL GA
30106-1121
US

IV. Provider business mailing address

683 LAKEVIEW TRL
MARIETTA GA
30068-2555
US

V. Phone/Fax

Practice location:
  • Phone: 470-732-4000
  • Fax:
Mailing address:
  • Phone: 214-924-3649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number0067-7443-5506
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: