{
"Npi": {
"NPI": "1497866248",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BRANER",
"FirstName": "HENRY",
"MiddleName": "J",
"NamePrefix": "MR.",
"NameSuffix": null,
"Credential": "PHYSICIAN ASSISTANT",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "603 PEAR ORCHARD LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "STATESBORO",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30458-6767",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "912-489-3938",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "16TH STREET BUILDING 13514",
"SecondLinePracticeLocationAddress": "YOUTH CHALLANGE ACADEMY",
"PracticeLocationAddressCityName": "FT STEWART",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "31315",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "912-242-6542",
"PracticeLocationAddressFaxNumber": "912-767-6445",
"EnumerationDate": "08/31/2006",
"LastUpdateDate": "03/28/2016",
"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": "363AM0700X",
"TaxonomyName": "Medical Physician Assistant",
"LicenseNumber": "001989",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}