Unknown Individual – Neurology Physician, NPI 1639351596

Unknown Individual is a healthcare provider. based in Fayetteville, Georgia. specializing in Neurology Physician. They hold a License No. 029568 (GA). The NPI Number for Unknown Individual is 1639351596

Main info

Organization
Inactive
44 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1639351596
Phone
(770) 634-1998
Address
PO BOX 142190
Deactivation Date
21 October 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
4234952525
Graduation Year
1982 (44 years ago)
PAC ID
2163512922
Group Practice PAC ID
8022919570
Professional Enrollment ID
I20170324001259
Data current as of
20 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

  • PO BOX 142190

    FAYETTEVILLE, GA 302146511

    Phone: (770) 634-1998

    Type: Mailing

  • 522, West Solomon Street, Griffin, Spalding County, Georgia, 30223, United States

    GRIFFIN, GA 302232834

    Phone: (770) 634-1998

    Type: Location

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 30214)

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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: 8022919570View full group profile
NameSpecialtyState
Nurse PractitionerTN
-KY
Radiation OncologyWV
Internal MedicineTN
Internal MedicineTN
-TN
-TN
Nurse PractitionerTN
Certified Registered Nurse Anesthetist (Crna)TN
Certified Registered Nurse Anesthetist (Crna)TN

Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1639351596 on file in the registry.
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 Neurology Physician. Clinical services aligned with this taxonomy classification.
What locale is associated with Unknown Individual?
Directory geography for Unknown Individual centers on Fayetteville, Georgia.
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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