Unknown Individual – Emergency Medicine Physician, NPI 1235633553

Unknown Individual is a healthcare provider. based in Norcross, Georgia. specializing in Emergency Medicine Physician. They hold a License No. 0101263804 (VA). The NPI Number for Unknown Individual is 1235633553

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1235633553
Phone
(470) 300-1190
Address
3240 POINTE PKWY STE 100
Deactivation Date
14 June 2022
Data current as of
20 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

  • 3240 POINTE PKWY STE 100

    NORCROSS, GA 300923389

    Phone: (470) 300-1190

    Type: Mailing

  • 7400 BEAUFONT SPRINGS DR STE 300

    NORTH CHESTERFIELD, VA 232255519

    Phone: (470) 300-1190

    Fax: (470) 273-7110

    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 30092)

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Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1235633553 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 expertise is attributed to Unknown Individual?
Unknown Individual's specialty line reads Emergency Medicine Physician. Clinical services aligned with this taxonomy classification.
Where in Georgia is Unknown Individual registered?
Use Norcross, 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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