{
"Npi": {
"NPI": "1396918637",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "AUGUSTUS MEDICAL PC",
"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": "1001 E WT HARRIS BLVD",
"SecondLineMailingAddress": "SUITE P311",
"MailingAddressCityName": "CHARLOTTE",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28213-4104",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "704-510-9481",
"MailingAddressFaxNumber": "704-510-9758",
"FirstLinePracticeLocationAddress": "1001 E WT HARRIS BLVD",
"SecondLinePracticeLocationAddress": "SUITE P311",
"PracticeLocationAddressCityName": "CHARLOTTE",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28213-4104",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "704-510-9481",
"PracticeLocationAddressFaxNumber": "704-510-9758",
"EnumerationDate": "04/08/2008",
"LastUpdateDate": "04/08/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "AUGUSTUS",
"AuthorizedOfficialFirstName": "CARL",
"AuthorizedOfficialMiddleName": "TRENT",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "704-510-9481",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": "9601218",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}