{
"Npi": {
"NPI": "1417332503",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CIVILIAN BARBER SURGEONS",
"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": "8079 TARA BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JONESBORO",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30236-3294",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "404-710-6136",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "8079 TARA BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "JONESBORO",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30236-3294",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "404-710-6136",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/30/2015",
"LastUpdateDate": "07/30/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DAVIS",
"AuthorizedOfficialFirstName": "KARRIEM",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "MASTER BARBER",
"AuthorizedOfficialNamePrefix": "PROF.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "BARBER",
"AuthorizedOfficialTelephoneNumber": "404-710-6136",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "291U00000X",
"TaxonomyName": "Clinical Medical Laboratory",
"LicenseNumber": "BR018793",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}