{
"Npi": {
"NPI": "1215579982",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WALKER",
"FirstName": "ANFERNEE",
"MiddleName": "JEROME",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "CSA",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "990 THOUSAND OAKS DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAWRENCEVILLE",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30043-3123",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "990 THOUSAND OAKS DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAWRENCEVILLE",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30043-3123",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "470-262-2848",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/14/2019",
"LastUpdateDate": "02/27/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "246ZC0007X",
"TaxonomyName": "Surgical Assistant",
"LicenseNumber": "5026",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "246ZC0007X",
"TaxonomyName": "Surgical Assistant",
"LicenseNumber": null,
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}