Unknown Individual – Family Nurse Practitioner, NPI 1497955629

Unknown Individual is a healthcare provider. based in Riverdale, Georgia. specializing in Family Nurse Practitioner. They hold a License No. RN171765 (GA). The NPI Number for Unknown Individual is 1497955629

Main info

Organization
Inactive
20 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1497955629
Phone
(770) 994-9326
Address
11 UPPER RIVERDALE RD SW
Deactivation Date
21 June 2023

Doctor Profile

Medical School Name
EMORY UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
4048518000
Graduation Year
2006 (20 years ago)
PAC ID
8325135502
Group Practice PAC ID
9335135144
Professional Enrollment ID
I20180522001600
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

  • 11, Upper Riverdale Road, Sherwood Park, Riverdale, Clayton County, Georgia, 30274, United States

    RIVERDALE, GA 302742615

    Phone: (770) 994-9326

    Fax: (770) 994-4747

    Type: Location

  • CVS Pharmacy, 235, Peachtree Street Northeast, Five Points, Atlanta, Fulton County, Georgia, 30303, United States

    NORTH TOWER, SUITE 2100

    ATLANTA, GA 303031401

    Phone: (770) 994-9326

    Fax: (770) 994-4747

    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 30274)

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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: 9335135144View full group profile
NameSpecialtyState
Emergency MedicineGA
Emergency MedicineGA
Emergency MedicineGA
Emergency MedicineKY
Emergency MedicineGA
Emergency MedicineAL
Nurse PractitionerGA
-GA
Emergency MedicineMI
Emergency MedicineGA

Reviews

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Frequently asked questions

Can I cross-check Unknown Individual using NPI 1497955629?
NPI 1497955629 belongs to Unknown Individual; compare other details if you need extra assurance.
Is inactive the same as retired for Unknown Individual?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What area of care is associated with Unknown Individual?
Unknown Individual's record emphasizes Family Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Where in Georgia is Unknown Individual registered?
Use Riverdale, Georgia as the headline location for Unknown Individual here.
Does Unknown Individual accept insurance?
Insurance participation is not part of the core NPI extract — call the plan or office to confirm.

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