Unknown Individual – Surgery Physician, NPI 1457317026

Surgery Physician

Unknown Individual is a healthcare provider. based in Decatur, Alabama. specializing in Surgery Physician. They hold a License No. 00003989 (AL). The NPI Number for Unknown Individual is 1457317026

Main info

Organization

Inactive

63 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1457317026

Phone

(256) 355-6414

Address

PO BOX 1029

Deactivation Date

20 February 2025

Doctor Profile

Medical School Name

LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN NEW ORLEANS

Secondary Phone

2563556414

Graduation Year

1963 (63 years ago)

PAC ID

7113023110

Group Practice PAC ID

4789607268

Professional Enrollment ID

I20100528000612

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness75

Years active:0State licenses:1Digital endpointsOther names

Loading map...

Provider Addresses for Unknown Individual

Decatur, Macon County, Illinois, United States
DECATUR, AL 356021029
Phone: (256) 355-6414
Fax: (256) 355-6646
Type: Mailing
1405, 7th Street Southeast, Albany, Decatur, Morgan County, Alabama, 35601, United States
DECATUR, AL 356013341
Phone: (256) 355-6414
Fax: (256) 355-6646
Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

Loading prescription activity...

Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 35602)

Loading plans...

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 4789607268View full group profile

Name	Specialty	State
RODNEY TYLER HARNEY (M.D.)	General Surgery	AL
JASON RANDALL SEALE (M.D.)	General Surgery	AL
DR. MATTHEW LEWIS FIGH (M.D.)	General Surgery	AL
DR. LYNN RANDOLPH BUCKNER (MD)	General Surgery	AL
DR. ROBERT CHARLES WALKER (MD)	-	AL
XIN HUANG	General Surgery	AL