Unknown Individual – Medical Physician Assistant, NPI 1609883016

Unknown Individual is a healthcare provider. based in Mcdonough, Georgia. specializing in Medical Physician Assistant. They hold a License No. 002525 (GA). The NPI Number for Unknown Individual is 1609883016

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1609883016
Phone
(404) 352-4500
Address
111 ROYAL BURGESS WAY
Deactivation Date
11 September 2025
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 111 ROYAL BURGESS WAY

    MCDONOUGH, GA 302534283

    Phone: (404) 352-4500

    Fax: (404) 350-0722

    Type: Mailing

  • 3200, Downwood Circle Northwest, A, Atlanta, Fulton County, Georgia, 30327, United States

    SUITE 500

    ATLANTA, GA 303271610

    Phone: (404) 352-4500

    Fax: (404) 350-0722

    Type: Location

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 $29.

Total Amount is formed as General ($29) + Research ($0) + Ownership ($0) = $29.

Last reported payment date: 2024-10-04 • Largest payer in this snapshot: Bioventus LLC ($17).

Total Amount

$29

General + Research + Ownership

Payments

2

Total payment records

General Amount

$29

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-10-04

Latest reported date

Top Companies

Largest payers in this snapshot

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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 30253)

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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 1609883016.
What is the next step if Unknown Individual is inactive?
Treat inactive as a signal to verify Unknown Individual through official channels.
What kind of provider is Unknown Individual?
The page reflects Medical Physician Assistant for Unknown Individual. Clinical services aligned with this taxonomy classification.
Does Unknown Individual practice in Georgia?
You will see Mcdonough, Georgia on file for Unknown Individual alongside any extra practice locations.
How can I contact Unknown Individual?
Phone or fax may appear on the official NPI record when supplied — verify before relying on them.