Unknown Individual – Acute Care Nurse Practitioner, NPI 1063722973

Acute Care Nurse Practitioner

Unknown Individual is a healthcare provider. based in Augusta, Georgia. specializing in Acute Care Nurse Practitioner. They hold a License No. R110631 (GA). The NPI Number for Unknown Individual is 1063722973

Main info

Organization

Inactive

34 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1063722973

Phone

(706) 721-3813

Address

1120 15TH ST STE BI1056

Deactivation Date

24 November 2021

Doctor Profile

Medical School Name

UNIVERSITY OF SOUTH FLORIDA COLLEGE OF MEDICINE

Secondary Phone

7067246100

Graduation Year

1992 (34 years ago)

PAC ID

5294053880

Group Practice PAC ID

7618866229

Professional Enrollment ID

I20161024002561

Data current as of

20 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

1120 15TH ST STE BI1056
AUGUSTA, GA 309120004
Phone: (706) 721-3813
Type: Mailing
1120 15TH STREET
AUGUSTA, GA 30912
Phone: (706) 721-3445
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 30912)

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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: 7618866229View full group profile

Name	Specialty	State
KARAH C TRAHAN (PA-C)	-	GA
LAURA J LOGUE (AOCNP)	-	GA
ELISE M HULSEBUS (PA)	-	GA
SARA H. LIEBEL (PA)	-	GA
DR. TRACIE L SPONSELLER (OD)	-	GA

Reviews

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Frequently asked questions

Can I use this page to confirm Unknown Individual's NPI?

Yes. Unknown Individual is listed with NPI 1063722973 in the public NPI dataset.

Is Unknown Individual's NPI deactivated?

The extract indicates Unknown Individual is not in an active NPI state.

What taxonomy line describes Unknown Individual?

For research purposes, treat Unknown Individual as Acute Care Nurse Practitioner in this dataset. Clinical services aligned with this taxonomy classification.

Where should I expect Unknown Individual on a map?

Expect Augusta, Georgia as a primary anchor for Unknown Individual unless the record lists multiple sites.

Is specialty guaranteed by NPI alone?

Taxonomy selections describe intent; scope of practice still follows state law.