{
"Npi": {
"NPI": "1548752652",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "VEGA",
"FirstName": "ANNA",
"MiddleName": "BROOKE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "SIMPSON",
"OtherFirstName": "ANNA",
"OtherMiddleName": "VEGA",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "MCD, CF-SLP",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "1001 BAKER AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "AUGUSTA",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30904-4103",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "334-730-8033",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5176 WRIGHTSBORO RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GROVETOWN",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30813-2802",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "334-730-8033",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/04/2018",
"LastUpdateDate": "06/04/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "390200000X",
"TaxonomyName": "Student in an Organized Health Care Education/Training Program",
"LicenseNumber": "PCET002704",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}