{
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"OrgName": "ST. MARYS OBSTETRICS & GYNECOLOGY, P. C.",
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"FirstLineMailingAddress": "203 LAKESHORE PT",
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"MailingAddressCityName": "SAINT MARYS",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31558-3843",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "912-729-6600",
"MailingAddressFaxNumber": "912-729-6616",
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"PracticeLocationAddressFaxNumber": "912-729-6616",
"EnumerationDate": "09/19/2007",
"LastUpdateDate": "09/19/2007",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "KADUM",
"AuthorizedOfficialFirstName": "FAREED",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "912-729-6600",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207V00000X",
"TaxonomyName": "Obstetrics & Gynecology Physician",
"LicenseNumber": "GA022993",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}