Unknown Individual – Anesthesiology Physician, NPI 1154449239

Unknown Individual is a healthcare provider. based in Atlanta, Georgia. specializing in Anesthesiology Physician. They hold a License No. 33543 (GA). The NPI Number for Unknown Individual is 1154449239

Main info

Organization
Inactive
41 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1154449239
Phone
(770) 396-6190
Address
1870 INDEPENDENCE SQ STE D
Deactivation Date
2 March 2022

Doctor Profile

Medical School Name
WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
4043510500
Graduation Year
1985 (41 years ago)
PAC ID
1658391057
Group Practice PAC ID
9133114234
Professional Enrollment ID
I20051130000559
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

  • 1870 INDEPENDENCE SQ STE D

    ATLANTA, GA 303385155

    Phone: (770) 396-6190

    Fax: (770) 396-5541

    Mailing address matches the actual address.

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 30338)

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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: 9133114234View full group profile
NameSpecialtyState
Anesthesiology AssistantGA
-PA
Anesthesiology AssistantGA
Anesthesiology AssistantGA
Anesthesiology AssistantGA
Anesthesiology AssistantFL
-FL
-GA

Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1154449239.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Anesthesiology Physician. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to Atlanta, Georgia in the data we show; additional addresses may exist on the full record.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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