{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "UNIQUE-N-ASSURANCE HEALTHCARE AGENCY LLC",
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"FirstName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "PO BOX 2145",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "STOCKBRIDGE",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30281-8909",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "888-541-5552",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "910 ARROWHEAD TRL # GA31088",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WARNER ROBINS",
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"PracticeLocationAddressTelephoneNumber": "888-541-5552",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/15/2012",
"LastUpdateDate": "03/15/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DUMAS",
"AuthorizedOfficialFirstName": "GWENDOLYN",
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"AuthorizedOfficialTitle": "CEO",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "478-228-1422",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "302R00000X",
"TaxonomyName": "Health Maintenance Organization",
"LicenseNumber": "076-R-1011",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}