Unknown Individual – Psychiatry Physician, NPI 1114902764

Unknown Individual is a healthcare provider. based in Augusta, Georgia. specializing in Psychiatry Physician. They hold a License No. 13721 (GA). The NPI Number for Unknown Individual is 1114902764

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1114902764
Phone
(706) 432-7893
Address
3421 MIKE PADGETT HWY
Deactivation Date
12 June 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

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Provider Addresses for Unknown Individual

  • 3421, Mike Padgett Highway, Apple Valley, Augusta, Richmond County, Georgia, 30906, United States

    AUGUSTA, GA 309063815

    Phone: (706) 432-7893

    Fax: (706) 432-3780

    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 30906)

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Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1114902764 as the unique 10-digit identifier.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What area of care is associated with Unknown Individual?
Unknown Individual's record emphasizes Psychiatry Physician. Clinical services aligned with this taxonomy classification.
Where in Georgia is Unknown Individual registered?
Use Augusta, Georgia as the headline location for Unknown Individual here.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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