{
"Npi": {
"NPI": "1447417639",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SUNCREST HOME HEALTH OF GEORGIA, INC",
"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": "9510 ORMSBY STATION RD STE 300",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LOUISVILLE",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "40223-5016",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "502-891-1000",
"MailingAddressFaxNumber": "502-891-1427",
"FirstLinePracticeLocationAddress": "2400 LAKE PARK DR SE STE 450",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SMYRNA",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30080-7644",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "770-429-1455",
"PracticeLocationAddressFaxNumber": "770-801-9529",
"EnumerationDate": "05/16/2008",
"LastUpdateDate": "04/29/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PROFFITT",
"AuthorizedOfficialFirstName": "JOSHUA",
"AuthorizedOfficialMiddleName": "L.",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "337-233-1307",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "033074",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}