{
"Npi": {
"NPI": "1487161766",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BALANCED ENERGY WELLNESS, LLC",
"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": "457 CASTLEWOOD RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TYRONE",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30290-2012",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "678-848-3319",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "259 HIGHWAY 74 N STE 2",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PEACHTREE CITY",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30269-3562",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "678-871-9642",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/08/2018",
"LastUpdateDate": "01/08/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WHITTLESEY",
"AuthorizedOfficialFirstName": "VIRGINIA",
"AuthorizedOfficialMiddleName": "RAWLS",
"AuthorizedOfficialTitle": "OWNER, LICENSED ACUPUNCTURIST",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LAC",
"AuthorizedOfficialTelephoneNumber": "678-871-9642",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "171100000X",
"TaxonomyName": "Acupuncturist",
"LicenseNumber": "353",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}