Unknown Individual – Psychiatry Physician, NPI 1093977126

Unknown Individual is a healthcare provider. based in Tybee island, Georgia. specializing in Psychiatry Physician. They hold a License No. 12565 (GA). The NPI Number for Unknown Individual is 1093977126

Main info

Organization
Inactive
58 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1093977126
Phone
(404) 402-6395
Address
114 San Marco Dr
Deactivation Date
30 October 2024

Doctor Profile

Medical School Name
MEDICAL COLLEGE OF GEORGIA SCHOOL OF MEDICINE
Secondary Phone
-
Graduation Year
1968 (58 years ago)
PAC ID
8426115205
Professional Enrollment ID
I20170504000639
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

  • 114 San Marco Dr

    Tybee Island, GA 313289706

    Phone: (404) 402-6395

    Type: Location

  • 114 SAN MARCO DR

    TYBEE ISLAND, GA 313289706

    Phone: (404) 402-6395

    Type: Mailing

  • North Davis Drive, Warner Robins, Houston County, Georgia, 31098, United States

    WARNER ROBINS, GA 31093

    Phone: (478) 449-4800

    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.

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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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99213Established patient office or other outpatient visit, 20-29 minutes2417$0
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Insurance plans in this area (ZIP 31328)

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Reviews

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Frequently asked questions

Where can patients find Unknown Individual's NPI?
You can confirm Unknown Individual with NPI 1093977126; it appears in the national provider directory.
Should I trust care from Unknown Individual if status is inactive?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
Does Unknown Individual list a primary specialty?
If you are matching referrals, note Psychiatry Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
Where does public data place Unknown Individual?
The snapshot lists Tybee Island, Georgia for Unknown Individual; download NPPES for the complete set.
What if Tybee Island, Georgia seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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