{
"Npi": {
"NPI": "1295342731",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "ANDERSON",
"FirstName": "EVELYN",
"MiddleName": "ANITA",
"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": "202 CHARLIE FULLER RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GRANTVILLE",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30220-2801",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "770-927-2290",
"MailingAddressFaxNumber": "404-522-2935",
"FirstLinePracticeLocationAddress": "202 CHARLIE FULLER RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GRANTVILLE",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30220-2801",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "770-927-2290",
"PracticeLocationAddressFaxNumber": "404-522-2935",
"EnumerationDate": "09/29/2020",
"LastUpdateDate": "09/29/2020",
"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": "3140N1450X",
"TaxonomyName": "Pediatric Skilled Nursing Facility",
"LicenseNumber": "113357",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}