Unknown Individual – Addiction Medicine (Preventive Medicine) Physician, NPI 1750391777
Addiction Medicine (Preventive Medicine) Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
37 PREVENTIVE MEDICINE in GA
Provider Addresses for Unknown Individual
Bulldog Mobile Repair, 125, South Milledge Avenue, Broad Acres, Athens, Clarke County, Georgia, 30605, United States
SUITE A
ATHENS, GA 306055660
Phone: (706) 991-9865
Fax: (424) 220-7408
Type: Mailing
125 S Milledge Ave
Suite A
Athens, GA 306055660
Phone: (706) 991-9865
Fax: (424) 220-7408
Type: Location
2 S MAIN ST STE 206
WATKINSVILLE, GA 306777101
Phone: (706) 991-9865
Fax: (424) 220-7408
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $22.
Total Amount is formed as General ($22) + Research ($0) + Ownership ($0) = $22.
Last reported payment date: 2023-06-02 • Largest payer in this snapshot: AstraZeneca Pharmaceuticals LP ($22).
Total Amount
$22
General + Research + Ownership
Payments
1
Total payment records
General Amount
$22
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-06-02
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| AstraZeneca Pharmaceuticals LP | $22 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20250319001186 | I | Preventive Medicine | GA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
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 30605)
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Reviews
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