{
"Npi": {
"NPI": "1700634870",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "ABAZIE",
"FirstName": "UGOCHI",
"MiddleName": "CHIZUOROM",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "M.D",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "OKEREKE",
"OtherFirstName": "UGOCHI",
"OtherMiddleName": "CHIZUOROM",
"OtherNamePrefix": "MISS",
"OtherNameSuffix": null,
"OtherCredential": "M.D",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "11 UPPER RIVERDALE ROAD SW",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RIVERDALE",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30274",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "770-991-8026",
"MailingAddressFaxNumber": "773-257-6027",
"FirstLinePracticeLocationAddress": "11 UPPER RIVERDALE ROAD SW",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RIVERDALE",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30274",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "770-991-8026",
"PracticeLocationAddressFaxNumber": "773-257-6027",
"EnumerationDate": "05/13/2024",
"LastUpdateDate": "08/15/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": "01/13/2025",
"NPIReactivationDate": "08/14/2025",
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "125083174",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "390200000X",
"TaxonomyName": "Student in an Organized Health Care Education/Training Program",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}