Healthcare Provider Details

I. General information

NPI: 1992616767
Provider Name (Legal Business Name): FABULOUS AUTOMOTIVE INTERNATIONAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 CHESTNUT DR
COVINGTON GA
30016-5581
US

IV. Provider business mailing address

5603 EMERALD GLN
STONE MOUNTAIN GA
30088-3468
US

V. Phone/Fax

Practice location:
  • Phone: 770-896-4582
  • Fax:
Mailing address:
  • Phone: 770-896-4582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: W NURSE
Title or Position: TRUSTEE
Credential:
Phone: 770-896-4582