Unknown Individual – Maternal & Fetal Medicine Physician, NPI 1376642777

Unknown Individual is a healthcare provider. based in Austell, Georgia. specializing in Maternal & Fetal Medicine Physician. They hold a License No. 034220 (GA). The NPI Number for Unknown Individual is 1376642777

Main info

Organization
Inactive
50 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1376642777
Phone
(770) 819-9211
Address
1700 HOSPITAL SOUTH DR
Deactivation Date
15 January 2026

Doctor Profile

Medical School Name
MICHIGAN STATE UNIVERSITY COLLEGE OF HUMAN MEDICINE
Secondary Phone
4046055000
Graduation Year
1976 (50 years ago)
PAC ID
6901968015
Group Practice PAC ID
8527105253
Professional Enrollment ID
I20081229000014
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

  • 1700 HOSPITAL SOUTH DR

    SUITE 504

    AUSTELL, GA 301066810

    Phone: (770) 819-9211

    Fax: (770) 819-9616

    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 30106)

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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: 8527105253View full group profile
NameSpecialtyState
-GA
Nurse PractitionerGA
Nurse PractitionerGA
Certified Nurse Midwife (Cnm)WA
O B S T E T R I C S/ G Y N E C O L O G YGA
O B S T E T R I C S/ G Y N E C O L O G YTX
O B S T E T R I C S/ G Y N E C O L O G YGA
Nurse PractitionerNJ

Reviews

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Frequently asked questions

What identifier follows Unknown Individual across health systems?
The NPI 1376642777 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.
What type of care does Unknown Individual provide?
Unknown Individual's profile centers on Maternal & Fetal Medicine Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual tied to Austell, Georgia?
If you are local to Austell, Georgia, Unknown Individual may be relevant to your search.
Can I verify credentials using only NPI?
NPI confirms identity in the directory; licensure and board certification require separate checks.

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