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1316560659 NPI number — O'KEITH WALLACE BS, MS, CAMS11

NPI Number: 1316560659
Health Care Provider/Practitioner: O'KEITH WALLACE BS, MS, CAMS11

Information about “1316560659” NPI (O'KEITH WALLACE BS, MS, CAMS11) exists in 1316560659 in HTML format HTML  |  1316560659 in plain Text format TXT  |  1316560659 in PDF (Portable Document Format) PDF  |  1316560659 in an XML format XML  formats.

NPI Number : 1316560659 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1316560659",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WALLACE",
    "FirstName": "O'KEITH",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "BS, MS, CAMS11",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4830 LAWRENCEVILLE HWY NW STE 2B",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LILBURN",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30047-3812",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "770-676-9216",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4830 LAWRENCEVILLE HWY NW STE 2B",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LILBURN",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30047-3812",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "770-676-9216",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/21/2020",
    "LastUpdateDate": "05/21/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101Y00000X",
        "TaxonomyName": "Counselor",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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