{
"Npi": {
"NPI": "1336497981",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PROFESSIONAL NURSING AND SUPPORT SERVICES LLC",
"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": "7626 ENOCH LAKE CIRCLE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAKE PARK",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31636",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "229-375-4635",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "7626 ENOCH LAKE CIR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAKE PARK",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "31636-3906",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "229-375-4635",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/29/2012",
"LastUpdateDate": "08/29/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WILLIAMS",
"AuthorizedOfficialFirstName": "LASHANDA",
"AuthorizedOfficialMiddleName": "LEATRICE",
"AuthorizedOfficialTitle": "ADMINISTRATOR/OWNER",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RN",
"AuthorizedOfficialTelephoneNumber": "229-375-4635",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "092-R-0897",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}