Unknown Individual – Internal Medicine Physician, NPI 1063415081

Unknown Individual is a healthcare provider. based in Hazlehurst, Georgia. specializing in Internal Medicine Physician. They hold a License No. 034779 (GA). The NPI Number for Unknown Individual is 1063415081

Main info

Organization
Inactive
38 Years Of Experience
Name
Unknown Individual
NPI
1063415081
Phone
(912) 375-0755
Address
15 YARBROUGH ST
Deactivation Date
26 December 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9123750755
Graduation Year
1988 (38 years ago)
PAC ID
3971597907
Group Practice PAC ID
1951330513
Professional Enrollment ID
I20040413000629
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

  • Yarbrough Street, Hazlehurst, Jeff Davis County, Georgia, 31539, United States

    HAZLEHURST, GA 315396341

    Phone: (912) 375-0755

    Fax: (912) 375-0756

    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 $94.

Total Amount is formed as General ($94) + Research ($0) + Ownership ($0) = $94.

Last reported payment date: 2024-02-27 • Largest payer in this snapshot: Lilly USA, LLC ($36).

Total Amount

$94

General + Research + Ownership

Payments

5

Total payment records

General Amount

$94

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-02-27

Latest reported date

Top Companies

Largest payers in this snapshot

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
99214Established patient office or other outpatient visit, 30-39 minutes1,310276$0
J1100Injection, dexamethasone sodium phosphate, 1 mg613101$0
J3301Injection, triamcinolone acetonide, not otherwise specified, 10 mg43693$0
80305Testing for presence of drug, read by direct observation36797$0
96372Injection of drug or substance under skin or into muscle225104$0
View full utilization report →

Insurance plans in this area (ZIP 31539)

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Provider's Procedures

Unknown Individual performs procedures in Internal Medicine Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
INTERNAL MEDICINEGA81002Urinalysis, manual test263210

Reviews

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Frequently asked questions

What unique ID ties claims to Unknown Individual?
NPI 1063415081 is assigned to Unknown Individual under the national enumeration system.
Why would Unknown Individual's listing show inactive?
Inactive in NPPES means the identifier is not currently active in that dataset.
Does Unknown Individual list a primary specialty?
If you are matching referrals, note Internal Medicine Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
Does Unknown Individual practice in Georgia?
You will see Hazlehurst, Georgia on file for Unknown Individual alongside any extra practice locations.
Is this NPI for an individual or an organization?
This listing corresponds to an Individual Provider.

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