Unknown Individual – Certified Registered Nurse Anesthetist, NPI 1477518983

Unknown Individual is a healthcare provider. based in Buckhead, Georgia. specializing in Certified Registered Nurse Anesthetist. They hold a License No. RN149521 (GA). The NPI Number for Unknown Individual is 1477518983

Main info

Organization
Inactive
22 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1477518983
Phone
Not provided
Address
104 SHADOW LAKE LN
Deactivation Date
22 September 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7706885334
Graduation Year
2004 (22 years ago)
PAC ID
7214975432
Group Practice PAC ID
5698001162
Professional Enrollment ID
I20050419000872
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

  • 104 SHADOW LAKE LN

    BUCKHEAD, GA 306253015

    Phone:

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

Loading prescription activity...

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 30625)

Loading plans...

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: 5698001162View full group profile
NameSpecialtyState
-GA
Certified Registered Nurse Anesthetist (Crna)GA
Certified Registered Nurse Anesthetist (Crna)GA

Reviews

All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.

No reviews yet. Be the first to share your experience — your opinion helps families compare providers.

Frequently asked questions

Does Unknown Individual share an NPI with anyone else?
NPI numbers are unique to each provider or organization — Unknown Individual uses 1477518983.
What dates should I check for Unknown Individual's activity?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual's primary classification?
Certified Registered Nurse Anesthetist is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
Where should I expect Unknown Individual on a map?
Expect Buckhead, Georgia as a primary anchor for Unknown Individual unless the record lists multiple sites.
Why does Unknown Individual have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

Similar Providers

DR. ARTHUR LYNN WOMBLE (CRNA, PHD)

Certified Registered Nurse Anesthetist
PO BOX 73709
NPI: 1699778803

LINDA FAYE HOBBS (C.R.N.A.)

Certified Registered Nurse Anesthetist
Chattanooga Avenue, Dalton, Whitfield County, Georgia, 30720, United States of America
NPI: 1124021126

TAMMY MAHROOS (CRNA)

Certified Registered Nurse Anesthetist
Scott Nixon Memorial Drive, Foxhall, Augusta, Richmond County, Georgia, 30907, United States
NPI: 1235132093

CAROLYN MASTRONI (CRNA)

Certified Registered Nurse Anesthetist
Scott Nixon Memorial Drive, Foxhall, Augusta, Richmond County, Georgia, 30907, United States
NPI: 1316940166

JANET SEGEN (CRNA)

Certified Registered Nurse Anesthetist
Scott Nixon Memorial Drive, Foxhall, Augusta, Richmond County, Georgia, 30907, United States of America
NPI: 1083617831

RUTH C PERRY (CRNA)

Certified Registered Nurse Anesthetist
Scott Nixon Memorial Drive, Foxhall, Augusta, Richmond County, Georgia, 30907, United States of America
NPI: 1003819871

MARCIA EVANS (CRNA)

Certified Registered Nurse Anesthetist
Scott Nixon Memorial Drive, Foxhall, Augusta, Richmond County, Georgia, 30907, United States of America
NPI: 1841293602

MR. JOHN KITCHENER ROGERS (CRNA)

Certified Registered Nurse Anesthetist
Georgetown Court, Wesleyan Estates, Macon, Bibb County, Georgia, 31210, United States
NPI: 1992708424

AMY DUFFY KINGRY (CRNA)

Certified Registered Nurse Anesthetist
1557, Janmar Road, Snellville, Gwinnett County, Georgia, 30078, United States
NPI: 1477558021