Unknown Individual – Neurological Surgery Physician, NPI 1811988017

Unknown Individual is a healthcare provider. based in Gainesville, Georgia. specializing in Neurological Surgery Physician. They hold a License No. 036584 (GA). The NPI Number for Unknown Individual is 1811988017

Main info

Organization
Inactive
42 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1811988017
Phone
(770) 718-1122
Address
PO BOX 658
Deactivation Date
13 September 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7707181122
Graduation Year
1984 (42 years ago)
PAC ID
0749234284
Group Practice PAC ID
2668465733
Professional Enrollment ID
I20081021000334
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • PO BOX 658

    GAINESVILLE, GA 305030658

    Phone: (770) 718-1122

    Fax: (770) 535-7445

    Type: Mailing

  • 1240, Jesse Jewell Parkway, Gainesville, Hall County, Georgia, 30501, United States

    STE 300

    GAINESVILLE, GA 305013861

    Phone: (770) 534-7200

    Fax: (678) 450-3778

    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 30503)

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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: 2668465733View full group profile
NameSpecialtyState
Internal MedicineGA
Nurse PractitionerGA
Nurse PractitionerGA
Family PracticeGA
-GA
General SurgeryGA
Diagnostic RadiologyGA
O B S T E T R I C S/ G Y N E C O L O G YGA
-GA
Certified Nurse Midwife (Cnm)GA

Reviews

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Frequently asked questions

What number should I use to identify Unknown Individual for billing?
Administrative and clinical systems typically use NPI 1811988017 for Unknown Individual.
What does inactive NPI status mean for Unknown Individual?
Inactive status means the NPI record is not marked active in the public file — verify before making care decisions.
What does the directory say Unknown Individual does?
Insurance directories may phrase it differently, but here Unknown Individual maps to Neurological Surgery Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual tied to Gainesville, Georgia?
If you are local to Gainesville, Georgia, Unknown Individual may be relevant to your search.
Can I export Unknown Individual's record?
You can download the official NPPES record; we summarize key fields for readability.

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