{
"Npi": {
"NPI": "1043225758",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CSA OF ATLANTA, 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": "1140 HAMMOND DR NE STE K",
"SecondLineMailingAddress": "SUITE 350",
"MailingAddressCityName": "ATLANTA",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30328-7274",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "678-735-3201",
"MailingAddressFaxNumber": "678-735-3207",
"FirstLinePracticeLocationAddress": "1140 HAMMOND DR NE STE K",
"SecondLinePracticeLocationAddress": "SUITE 350",
"PracticeLocationAddressCityName": "ATLANTA",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30328-7274",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "678-735-3201",
"PracticeLocationAddressFaxNumber": "678-735-3207",
"EnumerationDate": "07/30/2006",
"LastUpdateDate": "01/05/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CARROLL",
"AuthorizedOfficialFirstName": "VICKY",
"AuthorizedOfficialMiddleName": "B",
"AuthorizedOfficialTitle": "DIRECTOR OF OPERATIONS",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RN",
"AuthorizedOfficialTelephoneNumber": "678-735-3201",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "BL04-03274",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}