Unknown Individual – Geropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist, NPI 1063494268

Geropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist

Unknown Individual is a healthcare provider. based in Marietta, Georgia. specializing in Geropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist. They hold a License No. RN046959 (GA). The NPI Number for Unknown Individual is 1063494268

Main info

Organization

Inactive

34 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1063494268

Phone

(770) 644-1570

Address

2540 WINDY HILL RD SE

Deactivation Date

17 May 2023

Doctor Profile

Medical School Name

OTHER

Secondary Phone

7704222009

Graduation Year

1992 (34 years ago)

PAC ID

2163402777

Group Practice PAC ID

0042293573

Professional Enrollment ID

I20040723000657

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

WellStar Windy Hill Hospital, 2540, Windy Hill Road Southeast, Marietta, Cobb, Georgia, 30067, United States
MARIETTA, GA 300678605
Phone: (770) 644-1570
Fax: (770) 644-1576
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 30067)

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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: 0042293573View full group profile

Name	Specialty	State
BRITTANY CLARKE TOLIVER (MSN, PMHNP- BC)	Nurse Practitioner	GA
Unknown Individual	-	GA
VALENTINO VASY (MD)	P S Y C H I A T R Y	GA
MARLA FLEMING (APRN, CNSPMH-BC)	Nurse Practitioner	GA
DR. MICHAEL DAVID BANOV (MD)	P S Y C H I A T R Y	GA

Reviews

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Frequently asked questions

What number should I use to identify Unknown Individual for billing?

Administrative and clinical systems typically use NPI 1063494268 for Unknown Individual.

What happens when Unknown Individual's NPI is not active?

Public data lists Unknown Individual outside the active bucket for this identifier.

Which specialty label fits Unknown Individual?

NPPES ties Unknown Individual to Geropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist in the taxonomy section. Clinical services aligned with this taxonomy classification.

What city is tied to Unknown Individual?

The directory associates Unknown Individual with Marietta, Georgia. Check all listed addresses for suites or satellite offices.

Can I export Unknown Individual's record?

You can download the official NPPES record; we summarize key fields for readability.