NPI Code Detail JSON Logo

1093838401 NPI number — MIA BETTINA FELICIANO MATIAS M.D.

NPI Number: 1093838401
Health Care Provider/Practitioner: MIA BETTINA FELICIANO MATIAS M.D.

Information about “1093838401” NPI (MIA BETTINA FELICIANO MATIAS M.D.) exists in 1093838401 in HTML format HTML  |  1093838401 in plain Text format TXT  |  1093838401 in PDF (Portable Document Format) PDF  |  1093838401 in an XML format XML  formats.

NPI Number : 1093838401 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1093838401",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MATIAS",
    "FirstName": "MIA BETTINA",
    "MiddleName": "FELICIANO",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MATIAS",
    "OtherFirstName": "MIA",
    "OtherMiddleName": "BETTINA",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": "M.D.",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "111 EPPERSON ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ATHENS",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "37303-3478",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "423-745-5955",
    "MailingAddressFaxNumber": "423-745-6423",
    "FirstLinePracticeLocationAddress": "111 EPPERSON ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ATHENS",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "37303-3478",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "423-745-5955",
    "PracticeLocationAddressFaxNumber": "423-745-6423",
    "EnumerationDate": "04/09/2007",
    "LastUpdateDate": "03/11/2014",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "208000000X",
        "TaxonomyName": "Pediatrics Physician",
        "LicenseNumber": "MD49483",
        "LicenseNumberStateCode": "TN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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