{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "OGIAWESOME",
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"FirstLineMailingAddress": "109 CHESTERBROOK CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "STAFFORD",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "22554-4879",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "540-840-5388",
"MailingAddressFaxNumber": "571-406-6911",
"FirstLinePracticeLocationAddress": "109 CHESTERBROOK COURT",
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"PracticeLocationAddressCityName": "STAFFORD",
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"PracticeLocationAddressTelephoneNumber": "540-840-5388",
"PracticeLocationAddressFaxNumber": "571-406-6903",
"EnumerationDate": "09/01/2016",
"LastUpdateDate": "09/01/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "OBENG",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "540-848-5309",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Non-emergency Medical Transport (VAN)",
"LicenseNumber": "T25030193",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}