Provider Demographics
NPI:1538509856
Name:NIMMANA, BALA KONDAIAH (MD)
Entity Type:Individual
Prefix:MR
First Name:BALA
Middle Name:KONDAIAH
Last Name:NIMMANA
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2705
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-2705
Mailing Address - Country:US
Mailing Address - Phone:256-265-3880
Mailing Address - Fax:256-265-3886
Practice Address - Street 1:101 SIVLEY RD SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4421
Practice Address - Country:US
Practice Address - Phone:256-265-3880
Practice Address - Fax:256-265-3886
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL35370207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL35370OtherAL LICENSE NUMBER