Unknown Individual – Family Nurse Practitioner, NPI 1073643078

Unknown Individual is a healthcare provider. based in Smyrna, Georgia. specializing in Family Nurse Practitioner. They hold a License No. RN039884NP (GA). The NPI Number for Unknown Individual is 1073643078

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1073643078
Phone
(770) 333-8889
Address
1314 CONCORD RD SE
Deactivation Date
20 March 2025
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

Provider Addresses for Unknown Individual

  • 1314 CONCORD RD SE

    SMYRNA, GA 300804361

    Phone: (770) 333-8889

    Fax: (770) 333-8948

    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)

CMS reports 2 Open Payments records for all available years, with a total value of $36.

Total Amount is formed as General ($36) + Research ($0) + Ownership ($0) = $36.

Last reported payment date: 2024-04-16 • Largest payer in this snapshot: ABBVIE INC. ($36).

Total Amount

$36

General + Research + Ownership

Payments

2

Total payment records

General Amount

$36

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-04-16

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
ABBVIE INC.$36
View all Open Payments →|Open Payments Risk Radar →

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 30080)

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Reviews

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Frequently asked questions

What federal number belongs to Unknown Individual?
The federal identifier for Unknown Individual is NPI 1073643078.
Is Unknown Individual's inactive status permanent?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
What kind of provider is Unknown Individual?
The page reflects Family Nurse Practitioner for Unknown Individual. Clinical services aligned with this taxonomy classification.
What location metadata exists for Unknown Individual?
The page summarizes Smyrna, Georgia for Unknown Individual; expand the address list for detail.
Is Unknown Individual a real provider?
This page reflects official NPPES data for NPI 1073643078. Always confirm identity and privileges with the practice and licensing boards.

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