{
"Npi": {
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "AUGUSTA PRIMARY CARE SERVICES, LLC",
"LastName": null,
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"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3623 J DEWEY GRAY CIR",
"SecondLineMailingAddress": "SUITE 210",
"MailingAddressCityName": "AUGUSTA",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30909-6511",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "706-922-7670",
"MailingAddressFaxNumber": "706-922-7680",
"FirstLinePracticeLocationAddress": "3623 J DEWEY GRAY CIR",
"SecondLinePracticeLocationAddress": "SUITE 210",
"PracticeLocationAddressCityName": "AUGUSTA",
"PracticeLocationAddressStateName": "GA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "706-922-7670",
"PracticeLocationAddressFaxNumber": "706-922-7680",
"EnumerationDate": "09/26/2007",
"LastUpdateDate": "06/25/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MANIAM",
"AuthorizedOfficialFirstName": "PRAKASH",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PROVIDER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "706-922-7670",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "174400000X",
"TaxonomyName": "Specialist",
"LicenseNumber": "27620",
"LicenseNumberStateCode": "SC",
"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."
}
}
}
}