{
"Npi": {
"NPI": "1144244757",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CONCORD INC",
"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": "8046 ROSWELL RD",
"SecondLineMailingAddress": "STE 202",
"MailingAddressCityName": "ATLANTA",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30350",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "770-671-0657",
"MailingAddressFaxNumber": "770-393-0835",
"FirstLinePracticeLocationAddress": "3890 JOHNS CREEK PKWY",
"SecondLinePracticeLocationAddress": "STE 160",
"PracticeLocationAddressCityName": "SUWANEE",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30024",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "678-417-0122",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/27/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "M CORD",
"AuthorizedOfficialFirstName": "LISA",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "CORPORATE SECRETARY",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "770-671-0657",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PHRE008426",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}