{
"Npi": {
"NPI": "1649975731",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "ANTWI",
"FirstName": "MATILDA",
"MiddleName": "MABEL",
"NamePrefix": "MS.",
"NameSuffix": null,
"Credential": "NP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "ANTWI",
"OtherFirstName": "MATILDA",
"OtherMiddleName": "MABEL",
"OtherNamePrefix": "MISS",
"OtherNameSuffix": null,
"OtherCredential": "NP",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "715 RIVER RUSH DR # 715",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SUGAR HILL",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30518-7465",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "630-202-6958",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "715 RIVER RUSH DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SUGAR HILL",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30518-7465",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "630-202-6958",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/30/2023",
"LastUpdateDate": "03/30/2023",
"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": "F03230449",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}