{
"Npi": {
"NPI": "1104062355",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ELITE STAFFING GROUP FOR SURGICAL NURSES, LLC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "8376 CARLINGTON LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JONESBORO",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30236-3769",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "404-936-4936",
"MailingAddressFaxNumber": "770-252-1102",
"FirstLinePracticeLocationAddress": "500 W LANIER AVE",
"SecondLinePracticeLocationAddress": "SUITE 606A",
"PracticeLocationAddressCityName": "FAYETTEVILLE",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30214-7636",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "770-573-1876",
"PracticeLocationAddressFaxNumber": "770-252-1102",
"EnumerationDate": "12/17/2008",
"LastUpdateDate": "12/17/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RAINEY",
"AuthorizedOfficialFirstName": "VANESSA",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "CO-OWNER",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CNP",
"AuthorizedOfficialTelephoneNumber": "770-783-1200",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251J00000X",
"TaxonomyName": "Nursing Care Agency",
"LicenseNumber": "132138LGB",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}