Unknown Individual – Internal Medicine Physician, NPI 1033279005

Unknown Individual is a healthcare provider. based in Atlanta, Georgia. specializing in Internal Medicine Physician. They hold a License No. 060140 (GA). The NPI Number for Unknown Individual is 1033279005

Main info

Organization
Inactive
31 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1033279005
Phone
(404) 756-5271
Address
75 PIEDMONT AVE
Deactivation Date
15 March 2021

Doctor Profile

Medical School Name
UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE
Secondary Phone
2037777411
Graduation Year
1995 (31 years ago)
PAC ID
3173426616
Group Practice PAC ID
4183511538
Professional Enrollment ID
I20190307001071
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience23
Completeness75
Years active:0State licenses:2Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Piedmont Avenue Northeast, Atlanta, Georgia, 30308, United States

    STE. 700

    ATLANTA, GA 30303

    Phone: (404) 756-5271

    Fax: (404) 756-1402

    Type: Mailing

  • Grady Memorial Hospital, 80, Jesse Hill Junior Drive Southeast, Sweet Auburn, Old Fourth Ward, Atlanta, Fulton County, Georgia, 30303, United States

    ATLANTA, GA 30303

    Phone: (404) 616-4307

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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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 30303)

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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: 4183511538View full group profile
NameSpecialtyState
DAIJSIA MELENA BUBB (APRN)
Nurse PractitionerCT
SYDNEY HENCK (LCSW)
Clinical Social WorkerCT
ELLEN J WORMSER (CNM LNM)
-CT
RACHEL ROMERO (APRN)
Nurse PractitionerCT
DR. KYLE ELLIGERS (M.D.)
Family PracticeCT
REBECCA KIVELSON HOFER
Family PracticeCT
ELIZABETH MAGENHEIMER (FNP APRN)
-CT
DAMARIS RODRIGUEZ (LCSW)
-CT
KARLA TEJADA ARIAS (MD)
Internal Medicine, Geriatric MedicineIL
LUIS RIOS
Marriage And Family TherapistCT

Reviews

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Frequently asked questions

What is Unknown Individual's NPI number?
Unknown Individual's NPI is 1033279005 — the number used across U.S. healthcare to identify this provider.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with Internal Medicine Physician in the directory — Clinical services aligned with this taxonomy classification.
Where in Georgia is Unknown Individual registered?
Use Atlanta, Georgia as the headline location for Unknown Individual here.
Can I trust this NPI listing for Unknown Individual?
The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.