{
"Npi": {
"NPI": "1093387458",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MAIDS",
"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": "3109 JOHN MICHAEL DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SOUTHAVEN",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "38672-8597",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "662-347-2052",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "6831 CRUMPLER BLVD STE 100",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OLIVE BRANCH",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "38654-2055",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "901-487-1912",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/14/2021",
"LastUpdateDate": "07/14/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PATTERSON",
"AuthorizedOfficialFirstName": "CALINA",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "BILLER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "662-347-2052",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QR0405X",
"TaxonomyName": "Substance Use Disorder Rehabilitation Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}