{
"Npi": {
"NPI": "1093181000",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EMPOWER FAMILY MEDICINE",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "115 ANSLEY ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DECATUR",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30030-5211",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "404-295-6251",
"MailingAddressFaxNumber": "888-213-8479",
"FirstLinePracticeLocationAddress": "209 SWANTON WAY",
"SecondLinePracticeLocationAddress": "SUITE 101",
"PracticeLocationAddressCityName": "DECATUR",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30030-3274",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "404-981-6278",
"PracticeLocationAddressFaxNumber": "888-213-8479",
"EnumerationDate": "08/12/2015",
"LastUpdateDate": "08/12/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BLACK",
"AuthorizedOfficialFirstName": "MELISSA",
"AuthorizedOfficialMiddleName": "P",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "404-295-6251",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": "15074174",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}