{
"Npi": {
"NPI": "1285894378",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WESLEY DEE GRANGER, M.D., P.A.",
"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": "12 PROFESSIONAL PKWY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RIDGELAND",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "39157-4113",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "601-856-2460",
"MailingAddressFaxNumber": "601-856-4687",
"FirstLinePracticeLocationAddress": "12 PROFESSIONAL PKWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RIDGELAND",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "39157-4113",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "601-856-2460",
"PracticeLocationAddressFaxNumber": "601-856-4687",
"EnumerationDate": "06/11/2008",
"LastUpdateDate": "06/11/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GRANGER",
"AuthorizedOfficialFirstName": "WESLEY",
"AuthorizedOfficialMiddleName": "DEE",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "601-856-2460",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "305S00000X",
"TaxonomyName": "Point of Service",
"LicenseNumber": "11037",
"LicenseNumberStateCode": "MS",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "305R00000X",
"TaxonomyName": "Preferred Provider Organization",
"LicenseNumber": "11037",
"LicenseNumberStateCode": "MS",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}