Unknown Individual – Vascular Surgery Physician, NPI 1629154844

Unknown Individual is a healthcare provider. based in Augusta, Georgia. specializing in Vascular Surgery Physician. They hold a License No. 26138 (GA). The NPI Number for Unknown Individual is 1629154844

Main info

Organization
Inactive
48 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1629154844
Phone
(706) 738-3359
Address
2101 Central Avenue
Deactivation Date
17 June 2021

Doctor Profile

Medical School Name
MEDICAL COLLEGE OF GEORGIA SCHOOL OF MEDICINE
Secondary Phone
7067383359
Graduation Year
1978 (48 years ago)
PAC ID
5890703391
Group Practice PAC ID
8729038336
Professional Enrollment ID
I20110208000647
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

  • 2101 Central Avenue

    Augusta, GA 30904

    Phone: (706) 738-3359

    Fax: (706) 738-0565

    Type: Location

  • 2101, Central Avenue, Oglethorpe Homes, Augusta, Richmond County, Georgia, 30904, United States

    AUGUSTA, GA 30904

    Phone: (706) 738-3359

    Fax: (706) 738-0565

    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 30904)

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Provider's Procedures

Unknown Individual performs procedures in Vascular Surgery Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
GENERAL SURGERYGA93971Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers6462

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: 8729038336View full group profile
NameSpecialtyState
-GA

Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?
Unknown Individual — NPI 1629154844 — is the standard way to identify this listing.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What is Unknown Individual's specialty?
The listing groups Unknown Individual with Vascular Surgery Physician. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Augusta, Georgia may find Unknown Individual in results; validate coverage separately.
Is the information about Unknown Individual up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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