Unknown Individual – Dermatology Physician, NPI 1447350640

Unknown Individual is a healthcare provider. based in Fayetteville, Georgia. specializing in Dermatology Physician. They hold a License No. 012152 (GA). The NPI Number for Unknown Individual is 1447350640

Main info

Organization
Inactive
67 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1447350640
Phone
(770) 461-1335
Address
874 LANIER AVE W
Deactivation Date
26 December 2024

Doctor Profile

Medical School Name
WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
-
Graduation Year
1959 (67 years ago)
PAC ID
0143487181
Professional Enrollment ID
I20120203000413
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

  • Advanced Aesthetics, 874, West Lanier Avenue, Deep Forest, Fayetteville, Fayette County, Georgia, 30214, United States

    SUITE 270

    FAYETTEVILLE, GA 302147662

    Phone: (770) 461-1335

    Fax: (770) 461-5160

    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 2 Open Payments records for all available years, with a total value of $108.

Total Amount is formed as General ($108) + Research ($0) + Ownership ($0) = $108.

Last reported payment date: 2024-05-01 • Largest payer in this snapshot: Janssen Biotech, Inc. ($95).

Total Amount

$108

General + Research + Ownership

Payments

2

Total payment records

General Amount

$108

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-05-01

Latest reported date

Top Companies

Largest payers in this snapshot

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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
99213Established patient office or other outpatient visit, 20-29 minutes423230$0
17003Destruction of precancer skin growth, 2-14 growths8231$0
99203New patient office or other outpatient visit, 30-44 minutes7070$0
11102Biopsy of related skin growth, first growth6452$0
17000Destruction of precancer skin growth, 1 growth6152$0
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Insurance plans in this area (ZIP 30214)

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Provider's Procedures

Unknown Individual performs procedures in Dermatology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
DERMATOLOGYGA11101Biopsy of each additional growth of skin and/or tissue5850
DERMATOLOGYGA17003Destruction of 2-14 skin growths466136

Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1447350640 as the unique 10-digit identifier.
Is inactive the same as retired for Unknown Individual?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What expertise is attributed to Unknown Individual?
Unknown Individual's specialty line reads Dermatology Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual located near Fayetteville?
Unknown Individual currently maps to Fayetteville, Georgia in this extract.
When was this NPI issued?
Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.

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