{
"Npi": {
"NPI": "1215047535",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SOUTH CHARLESTON MEDICAL CENTER",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1176 E HOME RD",
"SecondLineMailingAddress": "SUITE O",
"MailingAddressCityName": "SPRINGFIELD",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "45503-2726",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "937-398-0051",
"MailingAddressFaxNumber": "937-398-0054",
"FirstLinePracticeLocationAddress": "1176 E HOME RD",
"SecondLinePracticeLocationAddress": "SUITE O",
"PracticeLocationAddressCityName": "SPRINGFIELD",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "45503-2726",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "937-398-0051",
"PracticeLocationAddressFaxNumber": "937-398-0054",
"EnumerationDate": "08/30/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WILLIAMS",
"AuthorizedOfficialFirstName": "MARVIN",
"AuthorizedOfficialMiddleName": "H.",
"AuthorizedOfficialTitle": "PHYSICIAN/OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "937-398-0051",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "35051235",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}