{
"Npi": {
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
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"OrgName": "NORTHEAST GEORGIA PLASTIC SURGERY ASSOCIATES, PLASTIC SURGERY CENTER",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"FirstLineMailingAddress": "1296 SIMS ST",
"SecondLineMailingAddress": "SUITE B",
"MailingAddressCityName": "GAINESVILLE",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30501-3850",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "770-534-1856",
"MailingAddressFaxNumber": "770-531-0355",
"FirstLinePracticeLocationAddress": "1296 SIMS ST",
"SecondLinePracticeLocationAddress": "SUITE B",
"PracticeLocationAddressCityName": "GAINESVILLE",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "770-534-1856",
"PracticeLocationAddressFaxNumber": "770-531-0355",
"EnumerationDate": "07/22/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RICHWINE",
"AuthorizedOfficialFirstName": "SAMUEL",
"AuthorizedOfficialMiddleName": "W.",
"AuthorizedOfficialTitle": "MEDICAL DIRECTOR",
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"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "M. D.",
"AuthorizedOfficialTelephoneNumber": "770-534-1856",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": "069-037",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}