{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "JAMES S SULLIVAN M.D. PA",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
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"FirstLineMailingAddress": "4300 MAIN ST W",
"SecondLineMailingAddress": "SUITE 16",
"MailingAddressCityName": "DOTHAN",
"MailingAddressStateName": "AL",
"MailingAddressPostalCode": "36301-1098",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "334-793-1038",
"MailingAddressFaxNumber": "334-615-8444",
"FirstLinePracticeLocationAddress": "4300 MAIN ST W",
"SecondLinePracticeLocationAddress": "SUITE 16",
"PracticeLocationAddressCityName": "DOTHAN",
"PracticeLocationAddressStateName": "AL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "334-793-1038",
"PracticeLocationAddressFaxNumber": "334-615-8444",
"EnumerationDate": "09/22/2006",
"LastUpdateDate": "07/25/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SULLIVAN",
"AuthorizedOfficialFirstName": "JAMES",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "334-793-1038",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "5184",
"LicenseNumberStateCode": "AL",
"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."
}
}
}
}