{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LOWTIDE PHARMACY ATLANTA LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherNamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "91135 EAST METRO PKWY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OXFORD",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30054-4226",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "470-682-2068",
"MailingAddressFaxNumber": "678-750-1035",
"FirstLinePracticeLocationAddress": "91135 EAST METRO PKWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OXFORD",
"PracticeLocationAddressStateName": "GA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "470-682-2068",
"PracticeLocationAddressFaxNumber": "678-750-1035",
"EnumerationDate": "09/24/2026",
"LastUpdateDate": "09/24/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ITEOGU",
"AuthorizedOfficialFirstName": "KELECHUKWU",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PIC/MANAGING PARTNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMD",
"AuthorizedOfficialTelephoneNumber": "478-954-2364",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "3336C0004X",
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"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}