{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "EYE KANDY LASHES BEAUTY BAR & BOUTIQUE",
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"NamePrefix": null,
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"FirstLineMailingAddress": "2365 POWDER SPRINGS RD SW",
"SecondLineMailingAddress": "SUITE 1215",
"MailingAddressCityName": "MARIETTA",
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"MailingAddressPostalCode": "30064-4567",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "770-702-5663",
"MailingAddressFaxNumber": "678-902-6833",
"FirstLinePracticeLocationAddress": "2365 POWDER SPRINGS RD SW",
"SecondLinePracticeLocationAddress": "SUITE 1215",
"PracticeLocationAddressCityName": "MARIETTA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "770-702-5663",
"PracticeLocationAddressFaxNumber": "678-902-6833",
"EnumerationDate": "12/10/2015",
"LastUpdateDate": "12/10/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KNIGHT",
"AuthorizedOfficialFirstName": "CORRINE",
"AuthorizedOfficialMiddleName": "SHARON",
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"AuthorizedOfficialCredential": "AMT, CO,",
"AuthorizedOfficialTelephoneNumber": "770-865-3111",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Health Maintenance Organization",
"LicenseNumber": "COSA051935",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}