{
"Npi": {
"NPI": "1467031732",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "ST. JEAN",
"FirstName": "JACK",
"MiddleName": "J.",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "MD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "ST JEAN",
"OtherFirstName": "JACK",
"OtherMiddleName": "J.",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "MD",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "3400 OLD MILTON PKWY STE 395",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ALPHARETTA",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30005-3707",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "678-384-4911",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3400 OLD MILTON PKWY",
"SecondLinePracticeLocationAddress": "BUILDING C, SUITE 395,",
"PracticeLocationAddressCityName": "ALPHARETTA",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30005-3707",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "678-384-4911",
"PracticeLocationAddressFaxNumber": "678-405-3259",
"EnumerationDate": "04/05/2021",
"LastUpdateDate": "08/21/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2084P0800X",
"TaxonomyName": "Psychiatry Physician",
"LicenseNumber": "103618",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}