Unknown Individual – Anesthesiologist Assistant, NPI 1093761975

Unknown Individual is a healthcare provider. based in Gainesville, Georgia. specializing in Anesthesiologist Assistant. They hold a License No. 004374 (GA). The NPI Number for Unknown Individual is 1093761975

Main info

Organization
Inactive
22 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1093761975
Phone
(770) 532-7179
Address
PO BOX 1076
Deactivation Date
14 June 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7705327179
Graduation Year
2004 (22 years ago)
PAC ID
1254395239
Group Practice PAC ID
2769381771
Professional Enrollment ID
I20041118000866
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

  • Gainesville Post Office, 4600, Southwest 34th Street, Gainesville, Alachua County, Florida, 32608, United States

    GAINESVILLE, GA 305031076

    Phone: (770) 532-7179

    Fax: (770) 534-1312

    Type: Mailing

  • Northeast Georgia Medical Center, 743, Spring Street Northeast, Gainesville, Hall County, Georgia, 30501, United States

    GAINESVILLE, GA 305013715

    Phone: (770) 532-7179

    Fax: (770) 534-1312

    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 30503)

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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: 2769381771View full group profile
NameSpecialtyState
A N E S T H E S I O L O G YTN
Anesthesiology AssistantGA
Anesthesiology AssistantGA
Anesthesiology AssistantGA
A N E S T H E S I O L O G YAL
A N E S T H E S I O L O G YGA
Anesthesiology, Critical Care (Intensivists)GA
Anesthesiology AssistantGA
Certified Registered Nurse Anesthetist (Crna)GA
Anesthesiology AssistantGA

Reviews

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Frequently asked questions

What is Unknown Individual's NPI number?
Unknown Individual's NPI is 1093761975 — the number used across U.S. healthcare to identify this provider.
Does inactive status mean Unknown Individual stopped practicing?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What expertise is attributed to Unknown Individual?
Unknown Individual's specialty line reads Anesthesiologist Assistant. Clinical services aligned with this taxonomy classification.
Is Unknown Individual located near Gainesville?
Unknown Individual currently maps to Gainesville, Georgia in this extract.
Does Unknown Individual accept insurance?
Insurance participation is not part of the core NPI extract — call the plan or office to confirm.

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