{
"Npi": {
"NPI": "1366612491",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SANDI J. STEPHENS INC.",
"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": "250 NORWOOD AVE NE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ATLANTA",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30317-1248",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "404-964-1072",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "431 W PONCE DE LEON AVE",
"SecondLinePracticeLocationAddress": "SUITE 7",
"PracticeLocationAddressCityName": "DECATUR",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30030-2458",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "404-964-1072",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/05/2008",
"LastUpdateDate": "03/05/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STEPHENS",
"AuthorizedOfficialFirstName": "SANDI",
"AuthorizedOfficialMiddleName": "JACQUELYN",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "404-964-1072",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "004092",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}