Unknown Individual – Family Medicine Physician, NPI 1790728863
Family Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Unknown Individual
105 CARNEGIE PL STE 103
FAYETTEVILLE, GA 302145900
Phone: (770) 716-7999
Fax: (770) 716-8444
Type: Location
4300 N POINT PKWY STE 300
ALPHARETTA, GA 300224102
Phone: (770) 442-1911
Fax: (770) 442-0306
Type: Mailing
289, Jonesboro Road, McDonough, Henry County, Georgia, 30253, United States
STE 255
MCDONOUGH, GA 302533725
Phone: (404) 520-0506
Type: Mailing
289 JONESBORO RD STE 255
MCDONOUGH, GA 302533725
Phone: (404) 520-0506
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.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2005-05-10
PECOS data refreshed: 2026-05-27
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 |
|---|---|---|---|---|
| I20050510000619 | I | Family Practice | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | 169 | 53 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 53 | 50 | $0 |
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 48 | 48 | $0 |
| 87804 | Detection test by immunoassay with direct visual observation for influenza virus | 26 | 13 | $0 |
| 99239 | Hospital discharge day management, more than 30 minutes | 21 | 21 | $0 |
Insurance plans in this area (ZIP 30214)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| HOSPITALIST | GA | 93010 | Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report | 39 | 39 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | FL | |
| - | GA | |
| - | GA | |
| Internal Medicine | FL | |
| Internal Medicine, Emergency Medicine, Hospitalist | NJ | |
| Internal Medicine | GA | |
| Internal Medicine | AL | |
| H O S P I T A L I S T | CA | |
| - | AL | |
| Physician Assistant | GA |
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