Unknown Individual – Cardiovascular Disease Physician, NPI 1902869084

Cardiovascular Disease Physician

Unknown Individual is a healthcare provider. based in Riverdale, Georgia. specializing in Cardiovascular Disease Physician. They hold a License No. 027432 (GA). The NPI Number for Unknown Individual is 1902869084

Main info

Organization

Inactive

59 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1902869084

Phone

(770) 991-2100

Address

6507 PROFESSIONAL PL

Deactivation Date

9 September 2022

Doctor Profile

Medical School Name

OTHER

Secondary Phone

7704540091

Graduation Year

1967 (59 years ago)

PAC ID

2961506209

Group Practice PAC ID

9537238480

Professional Enrollment ID

I20100825000311

Data current as of

19 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

6507, Professional Place, Riverdale, Clayton County, Georgia, 30274, United States
RIVERDALE, GA 302744941
Phone: (770) 991-2100
Fax: (770) 991-1385
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 30274)

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Provider's Procedures

Unknown Individual performs procedures in Cardiovascular Disease Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
CARDIOVASCULAR DISEASE (CARDIOLOGY)	GA	78452	Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	51	51
CARDIOVASCULAR DISEASE (CARDIOLOGY)	GA	93010	Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	322	284

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: 9537238480View full group profile

Name	Specialty	State
DR. GARY ROBERT BOTSTEIN (M.D.)	-	GA
STEPHEN D DAY (M.D.)	-	GA
KRISTINA L LUNDBERG (MD)	-	GA
MICHAEL BARRY STUBBS (M.D.)	-	GA
DR. VINUTHA ATMAKUR (MD)	-	MI
DR. THOMAS DOUGLAS CAIN (DPM)	-	GA
VERONICA D'ANTIGNAC	-	GA
DR. SHELANDRA BELL (D.O.)	-	GA
DR. QAMMAR N RASHID (M.D.)	-	GA
DEIRDRE Z JOINER-NICHOLS (M.D.)	-	GA

Reviews

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Frequently asked questions

How do I look up Unknown Individual by NPI?

Use NPI 1902869084 when you need to reference Unknown Individual in forms, claims, or directories.

Is Unknown Individual's inactive status permanent?

An inactive NPI does not by itself prove someone stopped practicing — check other sources.

Can you summarize Unknown Individual's specialty in plain language?

Clinically, the directory lists Unknown Individual with Cardiovascular Disease Physician. Clinical services aligned with this taxonomy classification.

What location metadata exists for Unknown Individual?

The page summarizes Riverdale, Georgia for Unknown Individual; expand the address list for detail.

Is this NPI for an individual or an organization?

This listing corresponds to an Individual Provider.