Unknown Individual – Clinical Social Worker, NPI 1083776603

Unknown Individual is a healthcare provider. based in Watkinsville, Georgia. specializing in Clinical Social Worker. They hold a License No. CSW003359 (GA). The NPI Number for Unknown Individual is 1083776603

Main info

Organization
Inactive
27 Years Of Experience
Name
Unknown Individual
NPI
1083776603
Phone
(706) 207-7519
Address
1353 JENNINGS MILL RD
Deactivation Date
19 June 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7062077519
Graduation Year
1999 (27 years ago)
PAC ID
5496854721
Professional Enrollment ID
I20070627000083
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

  • 1353 JENNINGS MILL RD

    SUITE D, BOX11

    WATKINSVILLE, GA 306777290

    Phone: (706) 207-7519

    Fax: (706) 510-2619

    Type: Location

  • 325, Brookstone Drive, Brookstone, Athens, Clarke County, Georgia, 30605, United States

    ATHENS, GA 306054335

    Phone: (706) 207-7519

    Fax: (706) 510-2619

    Type: Mailing

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.

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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.

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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 30677)

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Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1083776603 on file in the registry.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What area of care is associated with Unknown Individual?
Unknown Individual's record emphasizes Clinical Social Worker. Clinical services aligned with this taxonomy classification.
What locale is associated with Unknown Individual?
Directory geography for Unknown Individual centers on Watkinsville, Georgia.
When was this NPI issued?
Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.

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