{
"Npi": {
"NPI": "1225220379",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TIMOTHY L. GARDNER, DPM,PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "10810 PARKSIDE DR STE 202",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KNOXVILLE",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "37934-1981",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "865-218-7474",
"MailingAddressFaxNumber": "865-218-7475",
"FirstLinePracticeLocationAddress": "123 N 19TH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MIDDLESBORO",
"PracticeLocationAddressStateName": "KY",
"PracticeLocationAddressPostalCode": "40965-2865",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "606-248-2739",
"PracticeLocationAddressFaxNumber": "606-248-2730",
"EnumerationDate": "08/13/2007",
"LastUpdateDate": "10/17/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GARDNER",
"AuthorizedOfficialFirstName": "TIMOTHY",
"AuthorizedOfficialMiddleName": "LOGAN",
"AuthorizedOfficialTitle": "PODIATRIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPM",
"AuthorizedOfficialTelephoneNumber": "606-248-2739",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213ES0103X",
"TaxonomyName": "Foot & Ankle Surgery Podiatrist",
"LicenseNumber": "30924",
"LicenseNumberStateCode": "KY",
"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."
}
}
}
}