{
"Npi": {
"NPI": "1306521752",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SAVANNAH ORAL AND FACIAL SURGERY",
"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": "3700 INGLESIDE BLVD BLDG 100",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LADSON",
"MailingAddressStateName": "SC",
"MailingAddressPostalCode": "29456-4141",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "843-974-5236",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5010 PAULSEN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAVANNAH",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "31405-4513",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "843-762-9028",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/21/2023",
"LastUpdateDate": "06/21/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TYLER",
"AuthorizedOfficialFirstName": "LYNDA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CONTROLLER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "843-974-5236",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QS0112X",
"TaxonomyName": "Oral and Maxillofacial Surgery Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}