{
"Npi": {
"NPI": "1215377387",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CAROLINA ANTI-AGING AND NEUROPATHY, PLLC",
"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": "7476 WATERSIDE LOOP RD",
"SecondLineMailingAddress": "SUITE 600",
"MailingAddressCityName": "DENVER",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28037-7679",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "704-822-5433",
"MailingAddressFaxNumber": "704-822-5997",
"FirstLinePracticeLocationAddress": "7476 WATERSIDE LOOP RD",
"SecondLinePracticeLocationAddress": "SUITE 600",
"PracticeLocationAddressCityName": "DENVER",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28037-7679",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "704-822-5433",
"PracticeLocationAddressFaxNumber": "704-822-5997",
"EnumerationDate": "07/03/2013",
"LastUpdateDate": "07/03/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "POWELL",
"AuthorizedOfficialFirstName": "DEBRA",
"AuthorizedOfficialMiddleName": "D.",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PA-C",
"AuthorizedOfficialTelephoneNumber": "704-822-5433",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM1300X",
"TaxonomyName": "Multi-Specialty Clinic/Center",
"LicenseNumber": "190034",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}