{
"Npi": {
"NPI": "1023815628",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BIRMINGHAM FUNCTIONAL NEUROLOGY, LLC",
"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": "817 PRINCETON AVE SW STE 112",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BIRMINGHAM",
"MailingAddressStateName": "AL",
"MailingAddressPostalCode": "35211-1340",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "205-882-1348",
"MailingAddressFaxNumber": "205-882-1348",
"FirstLinePracticeLocationAddress": "817 PRINCETON AVE SW STE 112",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BIRMINGHAM",
"PracticeLocationAddressStateName": "AL",
"PracticeLocationAddressPostalCode": "35211-1340",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "205-882-1348",
"PracticeLocationAddressFaxNumber": "205-882-1348",
"EnumerationDate": "03/01/2025",
"LastUpdateDate": "03/01/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ARRIETA",
"AuthorizedOfficialFirstName": "BRANDON",
"AuthorizedOfficialMiddleName": "B.",
"AuthorizedOfficialTitle": "OWNER/FUNCTIONAL NEUROLOGIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MS, DC, DACNB",
"AuthorizedOfficialTelephoneNumber": "205-882-1348",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QR0400X",
"TaxonomyName": "Rehabilitation Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QM2500X",
"TaxonomyName": "Medical Specialty Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}