Unknown Individual – Podiatrist, NPI 1265482517

Unknown Individual is a healthcare provider. based in Atlanta, Georgia. specializing in Podiatrist. They hold a License No. POD000403 (GA). The NPI Number for Unknown Individual is 1265482517

Main info

Organization
Inactive
54 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1265482517
Phone
(404) 688-1350
Address
1046 RIDGE AVENUE S.W.
Deactivation Date
18 December 2020

Doctor Profile

Medical School Name
CALIFORNIA SCHOOL OF PODIATRIC MEDICINE
Secondary Phone
4046881350
Graduation Year
1972 (54 years ago)
PAC ID
7214948538
Group Practice PAC ID
6901700723
Professional Enrollment ID
I20061212000010
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

  • 1046 RIDGE AVENUE S.W.

    ATLANTA, GA 30315

    Phone: (404) 688-1350

    Fax: (404) 688-2962

    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 30315)

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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: 6901700723View full group profile
NameSpecialtyState
O B S T E T R I C S/ G Y N E C O L O G YTX
-GA
Pediatric MedicinePA
Internal Medicine, Infectious DiseaseGA
P O D I A T R YGA
O B S T E T R I C S/ G Y N E C O L O G YGA
Emergency MedicineGA
General SurgeryGA
General PracticeGA
Internal MedicineGA

Reviews

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Frequently asked questions

What federal number belongs to Unknown Individual?
The federal identifier for Unknown Individual is NPI 1265482517.
What is the next step if Unknown Individual is inactive?
Treat inactive as a signal to verify Unknown Individual through official channels.
Can you summarize Unknown Individual's specialty in plain language?
Clinically, the directory lists Unknown Individual with Podiatrist. Clinical services aligned with this taxonomy classification.
Does Unknown Individual practice in Georgia?
You will see Atlanta, Georgia on file for Unknown Individual alongside any extra practice locations.
Is Unknown Individual a real provider?
This page reflects official NPPES data for NPI 1265482517. Always confirm identity and privileges with the practice and licensing boards.

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