{
"Npi": {
"NPI": "1366057523",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1701 MCCORMICK DR # 120",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LARGO",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "20774-5329",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "301-883-7822",
"MailingAddressFaxNumber": "301-883-7890",
"FirstLinePracticeLocationAddress": "9314 PISCATAWAY RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CLINTON",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "20735-3630",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "301-883-7879",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/14/2020",
"LastUpdateDate": "12/16/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VICKS",
"AuthorizedOfficialFirstName": "TAMALA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CREDENTIALING SPECIALIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "301-883-7822",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "174H00000X",
"TaxonomyName": "Health Educator",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}