{
"Npi": {
"NPI": "1225402373",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HOMEGROWN PEDIATRIC DENTISTRY AND ORTHODONTICS",
"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": "1005 TIMBER LAKE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CUMMING",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30041-8606",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "386-212-6669",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "405 ARROWHEAD BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "JONESBORO",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30236-1254",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "770-471-1991",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/30/2015",
"LastUpdateDate": "11/30/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MCKELLAR",
"AuthorizedOfficialFirstName": "CHRISTINA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MEMBER/ PEDIATRIC DENTIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "386-212-6669",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223P0221X",
"TaxonomyName": "Pediatric Dentistry",
"LicenseNumber": "DN014531",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}