Healthcare Provider Details

I. General information

NPI: 1851286819
Provider Name (Legal Business Name): JIMMY NGUYEN FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 CUMMING HWY
SUGAR HILL GA
30518-6112
US

IV. Provider business mailing address

3027 JIM MOORE RD
DACULA GA
30019-1144
US

V. Phone/Fax

Practice location:
  • Phone: 678-546-4062
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN299943
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN299943
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN299943
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: