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1225423601 NPI number — MIRANDA COLLETTA HORTON M.D.

NPI Number: 1225423601
Health Care Provider/Practitioner: MIRANDA COLLETTA HORTON M.D.

Information about “1225423601” NPI (MIRANDA COLLETTA HORTON M.D.) exists in 1225423601 in HTML format HTML  |  1225423601 in plain Text format TXT  |  1225423601 in PDF (Portable Document Format) PDF  |  1225423601 in an XML format XML  formats.

NPI Number : 1225423601 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1225423601",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HORTON",
    "FirstName": "MIRANDA",
    "MiddleName": "COLLETTA",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "COLLETTA",
    "OtherFirstName": "MIRANDA",
    "OtherMiddleName": "DENISE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "300 SINGLETON RIDGE RD",
    "SecondLineMailingAddress": "ATTN PNS CREDENTIALING",
    "MailingAddressCityName": "CONWAY",
    "MailingAddressStateName": "SC",
    "MailingAddressPostalCode": "29526-9142",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "843-234-6946",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "620 SINGLETON RIDGE RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CONWAY",
    "PracticeLocationAddressStateName": "SC",
    "PracticeLocationAddressPostalCode": "29526-9154",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "843-347-7300",
    "PracticeLocationAddressFaxNumber": "843-347-8459",
    "EnumerationDate": "04/01/2015",
    "LastUpdateDate": "09/02/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207Y00000X",
          "TaxonomyName": "Otolaryngology Physician",
          "LicenseNumber": "86199",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Y00000X",
          "TaxonomyName": "Otolaryngology Physician",
          "LicenseNumber": "86510",
          "LicenseNumberStateCode": "SC",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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