Unknown Individual – Family Medicine Physician, NPI 1053428540

Unknown Individual is a healthcare provider. based in Dunwoody, Georgia. specializing in Family Medicine Physician. They hold a License No. 49072 (GA). The NPI Number for Unknown Individual is 1053428540

Main info

Organization
Inactive
36 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1053428540
Phone
(404) 778-6920
Address
4500 N SHALLOWFORD RD
Deactivation Date
5 March 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
4047787525
Graduation Year
1990 (36 years ago)
PAC ID
9234186867
Group Practice PAC ID
8820901408
Professional Enrollment ID
I20050405001107
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

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Provider Addresses for Unknown Individual

  • 4500, North Shallowford Road, Huntley Hills, Dunwoody, DeKalb County, Georgia, 30338, United States

    DUNWOODY, GA 303386476

    Phone: (404) 778-6920

    Fax: (404) 778-6901

    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.

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

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99214Established patient office or other outpatient visit, 30-39 minutes8465$0
99233Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes4912$0
99213Established patient office or other outpatient visit, 20-29 minutes3330$0
99215Established patient office or other outpatient visit, 40-54 minutes2414$0
View full utilization report →

Insurance plans in this area (ZIP 30338)

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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: 8820901408View full group profile
NameSpecialtyState
Interventional Cardiology, Cardiovascular Disease (Cardiology), Internal MedicineCA
Internal MedicineGA
Physician AssistantFL
Interventional Radiology, Diagnostic RadiologyKY
Anesthesiology AssistantGA
-CA
D E R M A T O L O G YGA
Interventional Radiology, Diagnostic RadiologyNC
Physician AssistantGA
-GA

Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1053428540 for Unknown Individual, then check state licensing separately.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Dunwoody, Georgia may find Unknown Individual in results; validate coverage separately.
Why does Unknown Individual have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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