{
"Npi": {
"NPI": "1376116806",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EAST GEORGIA HEALTHCARE CENTER INC",
"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": "215 N COLEMAN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SWAINSBORO",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30401-3530",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "478-237-2638",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "102 W SHORT ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SWAINSBORO",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30401",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "912-293-1476",
"PracticeLocationAddressFaxNumber": "912-537-6161",
"EnumerationDate": "07/22/2021",
"LastUpdateDate": "07/22/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SORRELLS",
"AuthorizedOfficialFirstName": "JILL",
"AuthorizedOfficialMiddleName": "R",
"AuthorizedOfficialTitle": "CFO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "478-419-1641",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}