{
"Npi": {
"NPI": "1013114552",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GEORGE E. DRAKE, M.D., P.C.",
"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": "732 S 11TH ST",
"SecondLineMailingAddress": "SUITE 100 #242",
"MailingAddressCityName": "NILES",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "49120-3368",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "269-687-9607",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1 S 5TH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NILES",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "49120-2710",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "269-687-9607",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/28/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DRAKE",
"AuthorizedOfficialFirstName": "GEORGE",
"AuthorizedOfficialMiddleName": "ERVING",
"AuthorizedOfficialTitle": "PRESIDENT OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "269-687-9607",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": "4301034140",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}