{
"Npi": {
"NPI": "1184264525",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KOENIG",
"FirstName": "DEJA",
"MiddleName": "SHARI",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "NP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "GRANT",
"OtherFirstName": "DEJA",
"OtherMiddleName": "SHARI",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "4034 OAK HILL RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DOUGLASVILLE",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30135-5026",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "516-830-5338",
"MailingAddressFaxNumber": "470-523-2573",
"FirstLinePracticeLocationAddress": "4400 BROWNSVILLE RD STE 105",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "POWDER SPRINGS",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30127-8902",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "516-830-5338",
"PracticeLocationAddressFaxNumber": "470-523-2573",
"EnumerationDate": "01/14/2020",
"LastUpdateDate": "10/29/2025",
"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": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "95013548",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "APRN-NP282683",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}