{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "ORTHO-P.O.D. INC.",
"LastName": null,
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"NamePrefix": null,
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"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1190 FIVE FORKS TRICKUM RD",
"SecondLineMailingAddress": "SUITE 5",
"MailingAddressCityName": "LAWRENCEVILLE",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30045-9392",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "770-995-4310",
"MailingAddressFaxNumber": "770-995-4320",
"FirstLinePracticeLocationAddress": "1190 FIVE FORKS TRICKUM RD",
"SecondLinePracticeLocationAddress": "SUITE 5",
"PracticeLocationAddressCityName": "LAWRENCEVILLE",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "770-995-4310",
"PracticeLocationAddressFaxNumber": "770-995-4320",
"EnumerationDate": "10/24/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LLENA",
"AuthorizedOfficialFirstName": "RONNIE",
"AuthorizedOfficialMiddleName": "TINIO",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CO",
"AuthorizedOfficialTelephoneNumber": "770-995-4310",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "335E00000X",
"TaxonomyName": "Prosthetic/Orthotic Supplier",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}