{
"Npi": {
"NPI": "1386202612",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "TATUM",
"FirstName": "EILEEN",
"MiddleName": "DILKS",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "11315 JOHNS CREEK PKWY STE 340",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JOHNS CREEK",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30097-2646",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "770-709-6922",
"MailingAddressFaxNumber": "770-709-6910",
"FirstLinePracticeLocationAddress": "11315 JOHNS CREEK PKWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "JOHNS CREEK",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30097-2645",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "770-709-6922",
"PracticeLocationAddressFaxNumber": "770-709-6910",
"EnumerationDate": "06/02/2019",
"LastUpdateDate": "12/27/2024",
"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": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "0116032629",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "101543",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}