{
"Npi": {
"NPI": "1336961119",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "GRADY MEMORIAL HOSPITAL CORPORATION",
"ParentOrgTIN": null,
"OrgName": "GRADY MEMORIAL HOSPITAL CORPORATION",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "80 JESSE HILL JR DR SE # 26019",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ATLANTA",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30303-3050",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "404-616-2219",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "80 JESSE HILL JR DR SE UNIT 12 CD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ATLANTA",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30303-3031",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "404-616-3525",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/31/2024",
"LastUpdateDate": "11/01/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JEFFERSON",
"AuthorizedOfficialFirstName": "TIMOTHY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "EXECUTIVE VP, GENERAL COUNSEL",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "ESQ",
"AuthorizedOfficialTelephoneNumber": "404-616-6180",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "283X00000X",
"TaxonomyName": "Rehabilitation Hospital",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}