Unknown Individual – Acute Care Nurse Practitioner, NPI 1194383075

Unknown Individual is a healthcare provider. based in Tifton, Georgia. specializing in Acute Care Nurse Practitioner. They hold a License No. RN207403 (GA). The NPI Number for Unknown Individual is 1194383075

Main info

Organization
Inactive
8 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1194383075
Phone
(229) 391-9281
Address
PO BOX 715
Deactivation Date
16 January 2025

Doctor Profile

Medical School Name
UNIVERSITY OF SOUTH ALABAMA COLLEGE OF MEDICINE
Secondary Phone
2293868373
Graduation Year
2018 (8 years ago)
PAC ID
9638507882
Group Practice PAC ID
0648255018
Professional Enrollment ID
I20200321000321
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness75
Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

  • PO BOX 715

    TIFTON, GA 317930715

    Phone: (229) 391-9281

    Fax: (229) 391-9857

    Type: Mailing

  • 110 E 13TH AVE

    CORDELE, GA 310154245

    Phone: (229) 273-0359

    Fax: (229) 273-0360

    Type: Mailing

  • 1205, Tift Avenue North, Tifton, Tift County, Georgia, 31794, United States

    TIFTON, GA 31794

    Phone: (229) 391-9281

    Fax: (229) 391-9857

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 56 Open Payments records for all available years, with a total value of $1,973.

Total Amount is formed as General ($1,973) + Research ($0) + Ownership ($0) = $1,973.

Last reported payment date: 2024-10-30 • Largest payer in this snapshot: Gilead Sciences, Inc. ($1,069).

Total Amount

$1,973

General + Research + Ownership

Payments

56

Total payment records

General Amount

$1,973

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-10-30

Latest reported date

View all Open Payments →|Open Payments Risk Radar →

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 31793)

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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: 0648255018View full group profile
NameSpecialtyState
Nurse PractitionerGA
Nurse PractitionerGA
Nurse PractitionerGA
-GA

Reviews

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Frequently asked questions

Can I cross-check Unknown Individual using NPI 1194383075?
NPI 1194383075 belongs to Unknown Individual; compare other details if you need extra assurance.
Is Unknown Individual still active if the NPI shows inactive?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
How would a patient describe Unknown Individual's focus?
For Unknown Individual, the primary taxonomy reads as Acute Care Nurse Practitioner. Clinical services aligned with this taxonomy classification.
What practice footprint exists for Unknown Individual?
Travel planning: use Tifton, Georgia as the reference point for Unknown Individual, then confirm.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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