Unknown Individual – General Practice Physician, NPI 1093904914
Excluded from federal healthcare programs (Medicare/Medicaid)
This provider is listed on the OIG List of Excluded Individuals/Entities (LEIE). Exclusion effective: 2021-05-25. Reason: Fraud, kickbacks, or other prohibited activities.
General Practice Physician
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Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Unknown Individual
PO BOX 276
MENLO, GA 307310276
Phone: (706) 862-1213
Fax: (706) 659-3539
Type: Mailing
2968 HIGHWAY 337
MENLO, GA 30731
Phone: (706) 862-1213
Fax: (706) 659-3539
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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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 ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 30731)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | GA | |
| - | GA |
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