Unknown Individual – Adult Health Nurse Practitioner, NPI 1790030815

Adult Health Nurse Practitioner

Unknown Individual is a healthcare provider. based in Valdosta, Georgia. specializing in Adult Health Nurse Practitioner. They hold a License No. RN054469 (GA). The NPI Number for Unknown Individual is 1790030815

Main info

Organization

Inactive

28 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1790030815

Phone

(229) 474-4101

Address

202 W GORDON ST STE A

Deactivation Date

16 February 2021

Doctor Profile

Medical School Name

OTHER

Secondary Phone

2294744101

Graduation Year

1998 (28 years ago)

PAC ID

7214188648

Group Practice PAC ID

3072805423

Professional Enrollment ID

I20160706001461

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

Provider Addresses for Unknown Individual

202 W GORDON ST STE A
VALDOSTA, GA 316014565
Phone: (229) 474-4101
Fax: (229) 474-4101
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)

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 31601)

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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: 3072805423View full group profile

Name	Specialty	State
EBONY HILLMON-SCRUGGS (DNP, FNP-C)	-	GA

Reviews

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Frequently asked questions

What unique ID ties claims to Unknown Individual?

NPI 1790030815 is assigned to Unknown Individual under the national enumeration system.

What is the next step if Unknown Individual is inactive?

Treat inactive as a signal to verify Unknown Individual through official channels.

What field does Unknown Individual work in?

You can think of Unknown Individual as practicing within Adult Health Nurse Practitioner. Clinical services aligned with this taxonomy classification.

Where is Unknown Individual's primary listing?

We display Valdosta, Georgia because that is what the record indicates for Unknown Individual.

Is Unknown Individual a real provider?

This page reflects official NPPES data for NPI 1790030815. Always confirm identity and privileges with the practice and licensing boards.