Unknown Individual – Specialist, NPI 1558319210

Unknown Individual is a healthcare provider. based in Macon, Georgia. specializing in Specialist. They hold a License No. GA 25180 (GA). The NPI Number for Unknown Individual is 1558319210

Main info

Organization
Inactive
44 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1558319210
Phone
(478) 405-2222
Address
3096 RIVERSIDE DR
Deactivation Date
23 August 2021

Doctor Profile

Medical School Name
VANDERBILT UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
4784052222
Graduation Year
1982 (44 years ago)
PAC ID
9537246640
Group Practice PAC ID
5294863122
Professional Enrollment ID
I20100513000310
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience23
Completeness75
Years active:0State licenses:2Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 3096, Riverside Drive, Thornwood, Macon, Bibb County, Georgia, 31210, United States

    SUITE D

    MACON, GA 312100420

    Phone: (478) 405-2222

    Fax: (478) 405-2229

    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 $45.

Total Amount is formed as General ($45) + Research ($0) + Ownership ($0) = $45.

Last reported payment date: 2024-09-05 • Largest payer in this snapshot: Abbott Laboratories ($45).

Total Amount

$45

General + Research + Ownership

Payments

2

Total payment records

General Amount

$45

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-09-05

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
Abbott Laboratories$45
View all Open Payments →|Open Payments Risk Radar →

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 31210)

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Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1558319210.
Why is Unknown Individual marked inactive in the NPI directory?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual's primary classification?
Other Service Providers is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Macon, Georgia may find Unknown Individual in results; validate coverage separately.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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