Unknown Individual – Psychologist, NPI 1265521736

Unknown Individual is a healthcare provider. based in Smyrna, Georgia. specializing in Psychologist. They hold a License No. 001343 (GA). The NPI Number for Unknown Individual is 1265521736

Main info

Organization
Inactive
38 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1265521736
Phone
(770) 431-2354
Address
4015 SOUTH COBB DR
Deactivation Date
5 March 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7704312354
Graduation Year
1988 (38 years ago)
PAC ID
8022267244
Group Practice PAC ID
5092611384
Professional Enrollment ID
I20121003000847
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

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Provider Addresses for Unknown Individual

  • 4015, South Cobb Drive, Smyrna, Cobb County, Georgia, 30080, United States

    #115

    SMYRNA, GA 30080

    Phone: (770) 431-2354

    Fax: (770) 436-7143

    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 30080)

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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: 5092611384View full group profile
NameSpecialtyState
Nurse PractitionerGA
Nurse PractitionerFL
-GA
-GA
Clinical PsychologistGA
Nurse PractitionerGA
Clinical PsychologistGA
Marriage And Family TherapistGA
P S Y C H I A T R YGA
Clinical PsychologistGA

Reviews

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Frequently asked questions

What identifier follows Unknown Individual across health systems?
The NPI 1265521736 uniquely identifies Unknown Individual in U.S. healthcare data.
What does inactive NPI status mean for Unknown Individual?
Inactive status means the NPI record is not marked active in the public file — verify before making care decisions.
Which specialty label fits Unknown Individual?
NPPES ties Unknown Individual to Psychologist in the taxonomy section. Clinical services aligned with this taxonomy classification.
Which community is linked to Unknown Individual?
Unknown Individual shows a connection to Smyrna, Georgia in registry-derived data.
Can I export Unknown Individual's record?
You can download the official NPPES record; we summarize key fields for readability.

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