{
"Npi": {
"NPI": "1942099510",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1701 MCCORMICK DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LARGO",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "20774-5329",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "240-302-8576",
"MailingAddressFaxNumber": "301-883-7890",
"FirstLinePracticeLocationAddress": "3003 HOSPITAL DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHEVERLY",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "20785-1194",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "301-883-7879",
"PracticeLocationAddressFaxNumber": "301-883-7890",
"EnumerationDate": "05/01/2025",
"LastUpdateDate": "12/16/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BUTLER",
"AuthorizedOfficialFirstName": "TAMALA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CREDENTIALING SPECIALIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "240-302-8576",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251K00000X",
"TaxonomyName": "Public Health or Welfare Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}