{
"Npi": {
"NPI": "1033303482",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DEPARTMENT OF VETERANS AFFAIRS",
"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": "4055 BROWNE CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CONLEY",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30288-6811",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "770-629-1761",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2675 N MARTIN ST",
"SecondLinePracticeLocationAddress": "BLDG 700",
"PracticeLocationAddressCityName": "EAST POINT",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30344-6948",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "404-321-6111",
"PracticeLocationAddressFaxNumber": "404-327-4028",
"EnumerationDate": "08/29/2007",
"LastUpdateDate": "08/29/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TURNER-REID",
"AuthorizedOfficialFirstName": "JENIFER",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CLINICAL COORDINATOR",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LCSW",
"AuthorizedOfficialTelephoneNumber": "404-321-6111",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101Y00000X",
"TaxonomyName": "Counselor",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}