1114175841 NPI number — SHONTINA JOHNSON FLOYD LCSW, CFSW, C-ASWCM

NPI Number: 1114175841
Health Care Provider/Practitioner: SHONTINA JOHNSON FLOYD LCSW, CFSW, C-ASWCM

NPI Number : 1114175841 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114175841",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FLOYD",
    "FirstName": "SHONTINA",
    "MiddleName": "JOHNSON",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LCSW, CFSW, C-ASWCM",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "JOHNSON",
    "OtherFirstName": "SHONTINA",
    "OtherMiddleName": "PATRYCE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1287 MARKS CHURCH RD STE 1",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "AUGUSTA",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30909-6330",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "706-373-0579",
    "MailingAddressFaxNumber": "844-385-8096",
    "FirstLinePracticeLocationAddress": "1287 MARKS CHURCH RD STE 1",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "AUGUSTA",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30909",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "706-373-0579",
    "PracticeLocationAddressFaxNumber": "844-385-8096",
    "EnumerationDate": "09/06/2008",
    "LastUpdateDate": "08/26/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "SW11594",
          "LicenseNumberStateCode": "SC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "CSW005198",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}