Unknown Individual – Pediatric Adolescent Medicine Physician, NPI 1467435610

Unknown Individual is a healthcare provider. based in Carrollton, Georgia. specializing in Pediatric Adolescent Medicine Physician. They hold a License No. 034652 (GA). The NPI Number for Unknown Individual is 1467435610

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1467435610
Phone
(770) 834-0606
Address
804 DIXIE ST
Deactivation Date
7 February 2024
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

  • 804, Dixie Street, Carrollton, Carroll County, Georgia, 30117, United States

    CARROLLTON, GA 301174416

    Phone: (770) 834-0606

    Fax: (770) 834-1833

    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 1 Open Payments records for all available years, with a total value of $150.

Total Amount is formed as General ($150) + Research ($0) + Ownership ($0) = $150.

Last reported payment date: 2023-03-09 • Largest payer in this snapshot: Corium, LLC ($150).

Total Amount

$150

General + Research + Ownership

Payments

1

Total payment records

General Amount

$150

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-03-09

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
Corium, LLC$150
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 30117)

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Reviews

All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.

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Frequently asked questions

What is the registry number for Unknown Individual?
The registry entry for Unknown Individual shows NPI 1467435610.
What happens when Unknown Individual's NPI is not active?
Public data lists Unknown Individual outside the active bucket for this identifier.
How should patients interpret Unknown Individual's specialty?
The extract shows Pediatric Adolescent Medicine Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
Can patients visit Unknown Individual in Carrollton, Georgia?
For routing, start with Carrollton, 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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