1073198875 NPI number — COURTNEY COLEY LMT, CD, CPD, CBC

NPI Number: 1073198875
Health Care Provider/Practitioner: COURTNEY COLEY LMT, CD, CPD, CBC

NPI Number : 1073198875 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1073198875",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "COLEY",
    "FirstName": "COURTNEY",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LMT, CD, CPD, CBC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "209 MISTY VALLEY LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BONAIRE",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "31005-3651",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "605-858-4532",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "205A OLD PERRY RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BONAIRE",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "31005-3718",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "478-365-7857",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/12/2021",
    "LastUpdateDate": "03/12/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "225700000X",
          "TaxonomyName": "Massage Therapist",
          "LicenseNumber": "MT011527",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "374J00000X",
          "TaxonomyName": "Doula",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "174N00000X",
          "TaxonomyName": "Lactation Consultant (Non-RN)",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}