{
"Npi": {
"NPI": "1457520660",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "MTBM GLOBAL REHABILITATION CONSULTANTS",
"ParentOrgTIN": null,
"OrgName": "MTBM GLOBAL REHABILITATION",
"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": "2890A GA HWY 212",
"SecondLineMailingAddress": "SUITE 239",
"MailingAddressCityName": "CONYERS",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30094",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "770-987-7414",
"MailingAddressFaxNumber": "770-987-3106",
"FirstLinePracticeLocationAddress": "2890A GA HWY 212",
"SecondLinePracticeLocationAddress": "SUITE 239",
"PracticeLocationAddressCityName": "CONYERS",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30094",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "770-987-7414",
"PracticeLocationAddressFaxNumber": "770-987-3106",
"EnumerationDate": "02/22/2008",
"LastUpdateDate": "05/15/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "REYES",
"AuthorizedOfficialFirstName": "SILVIO",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "LICENSED PROFESSIONAL COUNSELOR",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHD",
"AuthorizedOfficialTelephoneNumber": "770-987-7414",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101Y00000X",
"TaxonomyName": "Counselor",
"LicenseNumber": "4592",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}