{
"Npi": {
"NPI": "1023476496",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MADEQUEST LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2894 PORT ROYAL LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DECATUR",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30034-2770",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "404-729-2520",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3355 LENOX RD NE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ATLANTA",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30326-1394",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "702-608-6233",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/01/2016",
"LastUpdateDate": "02/22/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHAPPELL",
"AuthorizedOfficialFirstName": "TOMIKA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "NEURO-SPEECH-LANGUAGE PATHOLOGIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.A. CCC-SLP",
"AuthorizedOfficialTelephoneNumber": "404-729-2520",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251C00000X",
"TaxonomyName": "Developmentally Disabled Services Day Training Agency",
"LicenseNumber": "SLP007131",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}