{
"Npi": {
"NPI": "1043566854",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WILLIAMSON PSYCHIATRIC SERVICES",
"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": "215 LOGAN ST",
"SecondLineMailingAddress": "SUITE 21",
"MailingAddressCityName": "WILLIAMSON",
"MailingAddressStateName": "WV",
"MailingAddressPostalCode": "25661-3600",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "304-235-5556",
"MailingAddressFaxNumber": "304-235-5557",
"FirstLinePracticeLocationAddress": "215 LOGAN ST",
"SecondLinePracticeLocationAddress": "SUITE 21",
"PracticeLocationAddressCityName": "WILLIAMSON",
"PracticeLocationAddressStateName": "WV",
"PracticeLocationAddressPostalCode": "25661-3600",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "304-235-5556",
"PracticeLocationAddressFaxNumber": "304-235-5557",
"EnumerationDate": "07/30/2012",
"LastUpdateDate": "07/30/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "IYER",
"AuthorizedOfficialFirstName": "SHIVKUMAR",
"AuthorizedOfficialMiddleName": "LAKSHMINARAYAN",
"AuthorizedOfficialTitle": "OWNER/PROVIDER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "304-235-5556",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2084P0800X",
"TaxonomyName": "Psychiatry Physician",
"LicenseNumber": "18736",
"LicenseNumberStateCode": "WV",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}