{
"Npi": {
"NPI": "1639712649",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "HAYES",
"FirstName": "MARLANA",
"MiddleName": null,
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "NP-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "WISE",
"OtherFirstName": "MARLANA",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "NP-C",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "618 THORNTON RD STE 3-297",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LITHIA SPRINGS",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30122-1518",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "404-692-3189",
"MailingAddressFaxNumber": "470-329-0422",
"FirstLinePracticeLocationAddress": "112 HEAD AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TALLAPOOSA",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30176-1219",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "678-573-8004",
"PracticeLocationAddressFaxNumber": "470-329-0422",
"EnumerationDate": "10/22/2019",
"LastUpdateDate": "10/30/2025",
"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": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "F09190100",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "RNNP227300",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "346267",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}