{
"Npi": {
"NPI": "1306070875",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PORT CITY URGENT CARE L.L.C.",
"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": "502 WHEAT AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BAINBRIDGE",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "39819-4325",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "229-243-1045",
"MailingAddressFaxNumber": "229-243-1046",
"FirstLinePracticeLocationAddress": "502 WHEAT AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BAINBRIDGE",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "39819-4325",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "229-243-1045",
"PracticeLocationAddressFaxNumber": "229-243-1046",
"EnumerationDate": "05/12/2009",
"LastUpdateDate": "06/19/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HIGGINBOTHAM",
"AuthorizedOfficialFirstName": "JAMES",
"AuthorizedOfficialMiddleName": "C.",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.O.",
"AuthorizedOfficialTelephoneNumber": "229-243-1045",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QU0200X",
"TaxonomyName": "Urgent Care Clinic/Center",
"LicenseNumber": "028786",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}