{
"Npi": {
"NPI": "1962186759",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "FRAZIER",
"FirstName": "TATA-NISHA",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "CPS-MD, AD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4037 BROWNE CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CONLEY",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30288-6811",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "404-263-2478",
"MailingAddressFaxNumber": "404-973-0276",
"FirstLinePracticeLocationAddress": "504 FAIR ST SW",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ATLANTA",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30313-1206",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "470-896-6046",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/12/2023",
"LastUpdateDate": "06/12/2023",
"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": "175T00000X",
"TaxonomyName": "Peer Specialist",
"LicenseNumber": null,
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}