{
"Npi": {
"NPI": "1518148287",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ADVANTAGE DENTAL ORAL HEALTH AND VISION CENTER OF ALABAMA, P.C.",
"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": "3322 W END AVE STE 400",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NASHVILLE",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "37203-6805",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "629-999-5014",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2700 5TH AVE N",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BESSEMER",
"PracticeLocationAddressStateName": "AL",
"PracticeLocationAddressPostalCode": "35020-4170",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "256-741-7340",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/21/2007",
"LastUpdateDate": "12/30/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "EDMONDSON",
"AuthorizedOfficialFirstName": "SHERRIE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MANAGER, LICENSING & CREDENTIALING",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "629-999-5014",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "S-839-TA-366",
"LicenseNumberStateCode": "AL",
"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."
}
}
}
}