Unknown Individual – Anatomic Pathology & Clinical Pathology Physician, NPI 1063463008

Unknown Individual is a healthcare provider. based in Marietta, Georgia. specializing in Anatomic Pathology & Clinical Pathology Physician. They hold a License No. 036160 (GA). The NPI Number for Unknown Individual is 1063463008

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1063463008
Phone
(770) 793-5435
Address
677 CHURCH ST NE
Deactivation Date
25 October 2022
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

  • 677, Church Street Northeast, Elizabeth, Marietta, Cobb County, Georgia, 30060, United States

    MARIETTA, GA 300601101

    Phone: (770) 793-5435

    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.

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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 30060)

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Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1063463008 for Unknown Individual, then check state licensing separately.
Is Unknown Individual excluded from programs when inactive?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Anatomic Pathology & Clinical Pathology Physician. Clinical services aligned with this taxonomy classification.
Where should I expect Unknown Individual on a map?
Expect Marietta, Georgia as a primary anchor for Unknown Individual unless the record lists multiple sites.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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