{
"Npi": {
"NPI": "1366844367",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MIDDLE GEORGIA FAMILY REHAB",
"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": "100 HAMILTON POINTE DR",
"SecondLineMailingAddress": "P.O. BOX 1552",
"MailingAddressCityName": "BYRON",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31008",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "478-956-4916",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "100 HAMILTON POINTE DR.",
"SecondLinePracticeLocationAddress": "SUITE 115 & 120",
"PracticeLocationAddressCityName": "BYRON",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "31008",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "478-956-4916",
"PracticeLocationAddressFaxNumber": "478-956-0958",
"EnumerationDate": "09/22/2014",
"LastUpdateDate": "09/22/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HICKS",
"AuthorizedOfficialFirstName": "BRENDA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OFFICE MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "478-956-4916",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "302R00000X",
"TaxonomyName": "Health Maintenance Organization",
"LicenseNumber": "PT002436",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}