Unknown Individual – Family Medicine Physician, NPI 1114908175

Unknown Individual is a healthcare provider. based in Harrogate, Tennessee. specializing in Family Medicine Physician. They hold a License No. 3478 (TN). The NPI Number for Unknown Individual is 1114908175

Main info

Organization
Inactive
68 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1114908175
Phone
(423) 869-3684
Address
PO BOX 78
Deactivation Date
19 October 2021

Doctor Profile

Medical School Name
UNIVERSITY OF TENNESSEE, HSC, COLLEGE OF MEDICINE
Secondary Phone
4238693684
Graduation Year
1958 (68 years ago)
PAC ID
6709972532
Group Practice PAC ID
5395807010
Professional Enrollment ID
I20081215000268
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

  • PO BOX 78

    HARROGATE, TN 377520078

    Phone: (423) 869-3684

    Fax: (423) 869-5460

    Type: Mailing

  • Beech Street, Starbeck, Knaresborough, Harrogate, North Yorkshire, Yorkshire and the Humber, England, HG2 7PL, United Kingdom

    SUITE 1

    HARROGATE, TN 377528251

    Phone: (423) 869-3684

    Fax: (423) 869-5460

    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 37752)

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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: 5395807010View full group profile
NameSpecialtyState
Nurse PractitionerTN
Nurse PractitionerTN
Nurse PractitionerKY
-MN
Physician AssistantTN
-TN
Physician AssistantTN
Nurse PractitionerTN
Family PracticeTN

Reviews

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Frequently asked questions

Is there an official ID for Unknown Individual in U.S. healthcare records?
The official identifier for Unknown Individual is NPI 1114908175.
Can Unknown Individual still bill if the NPI is inactive?
Do not rely on inactive status alone — contact the provider for confirmation.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with Family Medicine Physician in the directory — Clinical services aligned with this taxonomy classification.
What practice footprint exists for Unknown Individual?
Travel planning: use Harrogate, Tennessee as the reference point for Unknown Individual, then confirm.
When was this NPI issued?
Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.

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