Unknown Individual – Specialist, NPI 1043376163

Unknown Individual is a healthcare provider. based in Marietta, Georgia. specializing in Specialist. They hold a License No. 010485 (GA). The NPI Number for Unknown Individual is 1043376163

Main info

Organization
Inactive
62 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1043376163
Phone
(404) 375-0299
Address
330 OLD ORCHARD CT
Deactivation Date
24 November 2021

Doctor Profile

Medical School Name
EMORY UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
2296716700
Graduation Year
1964 (62 years ago)
PAC ID
3779683651
Group Practice PAC ID
1153563770
Professional Enrollment ID
I20080528000009
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

Provider Addresses for Unknown Individual

  • 330 OLD ORCHARD CT

    MARIETTA, GA 300683440

    Phone: (404) 375-0299

    Fax: (770) 971-8284

    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)

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 30068)

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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: 1153563770View full group profile

Reviews

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Frequently asked questions

What is Unknown Individual's NPI number?
Unknown Individual's NPI is 1043376163 — the number used across U.S. healthcare to identify this provider.
Is inactive the same as retired for Unknown Individual?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What area of care is associated with Unknown Individual?
Unknown Individual's record emphasizes Other Service Providers. Clinical services aligned with this taxonomy classification.
Where in Georgia is Unknown Individual registered?
Use Marietta, Georgia as the headline location for Unknown Individual here.
Does Unknown Individual accept insurance?
Insurance participation is not part of the core NPI extract — call the plan or office to confirm.

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