Unknown Individual – Family Medicine Physician, NPI 1437166733

Family Medicine Physician

Unknown Individual is a healthcare provider. based in Canton, Georgia. specializing in Family Medicine Physician. They hold a License No. 015769 (GA). The NPI Number for Unknown Individual is 1437166733

Main info

Organization

Inactive

55 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1437166733

Phone

(770) 479-5535

Address

320 HOSPITAL RD

Deactivation Date

16 September 2021

Doctor Profile

Medical School Name

UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON

Secondary Phone

8002485535

Graduation Year

1971 (55 years ago)

PAC ID

8123200623

Group Practice PAC ID

1355578485

Professional Enrollment ID

I20110304000162

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

320, Hospital Road, North Canton, Canton, Cherokee County, Georgia, 30114, United States
CANTON, GA 301142432
Phone: (770) 479-5535
Fax: (770) 479-8821
Type: Location
Hospital Road, North Canton, Canton, Cherokee County, Georgia, 30114, United States
CANTON, GA 301142432
Phone: (770) 479-5535
Type: Mailing

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 30114)

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Provider's Procedures

Unknown Individual performs procedures in Family Medicine Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
FAMILY MEDICINE	GA	81002	Urinalysis, manual test	304	270
FAMILY MEDICINE	GA	83036	Hemoglobin A1C level	90	62
FAMILY MEDICINE	GA	85610	Blood test, clotting time	227	17

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: 1355578485View full group profile

Name	Specialty	State
CHRISTINA POWERS (MD)	Internal Medicine	SC
MR. DIPAKKUMAR PREMANAND AMIN (M.D.)	Family Practice	GA
NOKUTHULA NONDUMISO MSIMANGA (MD)	Family Practice, Geriatric Medicine, Hospice/Palliative Care	GA
KRISTIN OLIVER (FNP-C)	Nurse Practitioner	GA
FARYAL STERGER (APRN, FNP)	Nurse Practitioner	GA
RIKKI LITTLE	Nurse Practitioner	GA
LANA LAW	Internal Medicine	GA
MRS. JILL MARIE NORTHOVER (APRN, NP-C)	-	GA
ANNE BERRY TODD (M.D.)	Family Practice	GA
DR. NONNA R LIVITS (MD)	Family Practice	GA