{
"Npi": {
"NPI": "1124356399",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "GIBSON",
"FirstName": "STEPHANIE",
"MiddleName": "LEWIS",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "LEWIS",
"OtherFirstName": "STEPHANIE",
"OtherMiddleName": "ABIGAIL",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "9 RICHLAND MEDICAL PARK DR STE 320",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COLUMBIA",
"MailingAddressStateName": "SC",
"MailingAddressPostalCode": "29203-6845",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "803-733-5969",
"MailingAddressFaxNumber": "803-753-5591",
"FirstLinePracticeLocationAddress": "9 RICHLAND MEDICAL PARK DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "COLUMBIA",
"PracticeLocationAddressStateName": "SC",
"PracticeLocationAddressPostalCode": "29203-6859",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "803-434-6455",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/30/2009",
"LastUpdateDate": "04/01/2021",
"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": "208000000X",
"TaxonomyName": "Pediatrics Physician",
"LicenseNumber": "LL35801",
"LicenseNumberStateCode": "SC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}