Unknown Individual – Medical Physician Assistant, NPI 1013004027

Unknown Individual is a healthcare provider. based in Clarkesville, Georgia. specializing in Medical Physician Assistant. They hold a License No. 004862 (GA). The NPI Number for Unknown Individual is 1013004027

Main info

Organization
Inactive
21 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1013004027
Phone
(706) 754-5991
Address
5330 HIGHWAY 115
Deactivation Date
29 April 2023

Doctor Profile

Medical School Name
MEDICAL UNIVERSITY OF SOUTH CAROLINA COLLEGE OF MEDICINE
Secondary Phone
7067545991
Graduation Year
2005 (21 years ago)
PAC ID
9436157658
Group Practice PAC ID
9739464496
Professional Enrollment ID
I20061127000143
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Toccoa Highway, Clarkesville, Habersham County, Georgia, 30325, United States

    CLARKESVILLE, GA 305236730

    Phone: (706) 754-5991

    Fax: (706) 754-6736

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 5 Open Payments records for all available years, with a total value of $92.

Total Amount is formed as General ($92) + Research ($0) + Ownership ($0) = $92.

Last reported payment date: 2023-03-01 • Largest payer in this snapshot: Dermavant Sciences, Inc. ($36).

Total Amount

$92

General + Research + Ownership

Payments

5

Total payment records

General Amount

$92

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-03-01

Latest reported date

View all Open Payments →|Open Payments Risk Radar →

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
17003Destruction of precancer skin growth, 2-14 growths433111$0
99213Established patient office or other outpatient visit, 20-29 minutes187187$0
17000Destruction of precancer skin growth, 1 growth168166$0
17004Destruction of precancer skin growth, 15 or more growths144144$0
99214Established patient office or other outpatient visit, 30-39 minutes115114$0
View full utilization report →

Insurance plans in this area (ZIP 30523)

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Provider's Procedures

Unknown Individual performs procedures in Medical Physician Assistant. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
PHYSICIAN ASSISTANTGA11101Biopsy of each additional growth of skin and/or tissue155127

Reviews

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Frequently asked questions

What NPI should I save for Unknown Individual?
Save NPI 1013004027 if you need a stable reference for Unknown Individual.
Should I trust care from Unknown Individual if status is inactive?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
What kind of provider is Unknown Individual?
The page reflects Medical Physician Assistant for Unknown Individual. Clinical services aligned with this taxonomy classification.
What location metadata exists for Unknown Individual?
The page summarizes Clarkesville, Georgia for Unknown Individual; expand the address list for detail.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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