Unknown Individual – Clinical Social Worker, NPI 1912365271

Unknown Individual is a healthcare provider. based in Moultrie, Georgia. specializing in Clinical Social Worker. They hold a License No. CSW004973 (GA). The NPI Number for Unknown Individual is 1912365271

Main info

Organization
Inactive
17 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1912365271
Phone
(229) 985-4815
Address
3015 VETERANS PKWY S
Deactivation Date
7 December 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2299854815
Graduation Year
2009 (17 years ago)
PAC ID
0143526517
Group Practice PAC ID
1052305786
Professional Enrollment ID
I20160310001395
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

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Provider Addresses for Unknown Individual

  • Veterans Pkwy., Moultrie, Colquitt County, Georgia, United States

    MOULTRIE, GA 317886705

    Phone: (229) 985-4815

    Fax: (229) 890-6777

    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 31788)

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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: 1052305786View full group profile
NameSpecialtyState
Clinical Social WorkerGA
-GA
Nurse PractitionerGA
Physician AssistantGA
Physician AssistantGA
P S Y C H I A T R YGA
Physician AssistantGA
P S Y C H I A T R YGA
-GA
Nurse PractitionerGA

Reviews

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Frequently asked questions

What is the registry number for Unknown Individual?
The registry entry for Unknown Individual shows NPI 1912365271.
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 type of care does Unknown Individual provide?
Unknown Individual's profile centers on Clinical Social Worker. Clinical services aligned with this taxonomy classification.
Is Unknown Individual tied to Moultrie, Georgia?
If you are local to Moultrie, Georgia, Unknown Individual may be relevant to your search.
What is the difference between NPI and a medical license?
An NPI is a federal identifier; a medical license is issued by a state and governs where someone may practice.

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