Unknown Individual – Family Medicine Physician, NPI 1215935507

Unknown Individual is a healthcare provider. based in Conyers, Georgia. specializing in Family Medicine Physician. They hold a License No. 33847 (GA). The NPI Number for Unknown Individual is 1215935507

Main info

Organization
Inactive
53 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1215935507
Phone
(770) 929-0813
Address
2020 HONEY CREEK PKWY SE
Deactivation Date
20 March 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7709290813
Graduation Year
1973 (53 years ago)
PAC ID
3971496845
Group Practice PAC ID
4284527151
Professional Enrollment ID
I20100920000886
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

  • 2020 HONEY CREEK PKWY SE

    CONYERS, GA 300132974

    Phone: (770) 929-0813

    Fax: (770) 922-8653

    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)

CMS reports 74 Open Payments records for all available years, with a total value of $1,430.

Total Amount is formed as General ($1,430) + Research ($0) + Ownership ($0) = $1,430.

Last reported payment date: 2024-12-10 • Largest payer in this snapshot: Lilly USA, LLC ($358).

Total Amount

$1,430

General + Research + Ownership

Payments

74

Total payment records

General Amount

$1,430

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-10

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.

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

HCPCSDescriptionServicesBeneficiariesMedicare allowed
J1100Injection, dexamethasone sodium phosphate, 1 mg74254$0
99214Established patient office or other outpatient visit, 30-39 minutes502172$0
83036Hemoglobin a1c level15786$0
82962Blood glucose (sugar) test performed by hand-held instrument14776$0
81003Automated urinalysis test13794$0
View full utilization report →

Insurance plans in this area (ZIP 30013)

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Provider's Procedures

Unknown Individual performs procedures in Family Medicine Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
FAMILY MEDICINEGA20610Aspiration and/or injection of large joint or joint capsule3214
FAMILY MEDICINEGA92567Eardrum testing using ear probe2422
FAMILY MEDICINEGA93922Ultrasound study of arteries of both arms and legs3333

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: 4284527151View full group profile
NameSpecialtyState
Family PracticeGA
Family PracticeGA
Physician AssistantFL
Physician AssistantGA
-GA
Family PracticeGA

Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?
Unknown Individual — NPI 1215935507 — is the standard way to identify this listing.
What dates should I check for Unknown Individual's activity?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual's primary classification?
Family Medicine Physician is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to Conyers, Georgia in the data we show; additional addresses may exist on the full record.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

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