{
"Npi": {
"NPI": "1932477981",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "HATHAWAY",
"FirstName": "NATHANAEL",
"MiddleName": "EDWARD",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "HATHAWAY",
"OtherFirstName": "NATE",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "M.D.",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "7950 MARTIN LOOP",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FORT BENNING",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31905-5648",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "703-389-2695",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "9300 DEWITT LOOP",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FORT BELVOIR",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "22060-5285",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "619-889-4060",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/06/2011",
"LastUpdateDate": "12/23/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"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": "0101250715",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207N00000X",
"TaxonomyName": "Dermatology Physician",
"LicenseNumber": "0101250715",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}