Unknown Individual – Family Medicine Physician, NPI 1114090313

Unknown Individual is a healthcare provider. based in Baxley, Georgia. specializing in Family Medicine Physician. They hold a License No. 25663 (GA). The NPI Number for Unknown Individual is 1114090313

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1114090313
Phone
(912) 367-2711
Address
437 WEST PARKER STREET
Deactivation Date
9 November 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

  • West Parker Street, Bassville, Baxley, Appling County, Georgia, 31513, United States

    BAXLEY, GA 31513

    Phone: (912) 367-2711

    Fax: (912) 367-1132

    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 31513)

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Reviews

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Frequently asked questions

What number should I use to identify Unknown Individual for billing?
Administrative and clinical systems typically use NPI 1114090313 for Unknown Individual.
Does inactive mean outdated data for Unknown Individual?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 Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Can patients visit Unknown Individual in Baxley, Georgia?
For routing, start with Baxley, Georgia for Unknown Individual, then verify phone and hours locally.
Who maintains Unknown Individual's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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