{
"Npi": {
"NPI": "1558311969",
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "WILLIAMS MEDICAL GROUP, P.C.",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 1039",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FULLERTON",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92836-1039",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "415-595-6734",
"MailingAddressFaxNumber": "714-526-3110",
"FirstLinePracticeLocationAddress": "111 N TAYLOR AVE",
"SecondLinePracticeLocationAddress": "SUITE A",
"PracticeLocationAddressCityName": "KIRKWOOD",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "63122-4358",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "314-822-9997",
"PracticeLocationAddressFaxNumber": "314-822-9994",
"EnumerationDate": "05/10/2006",
"LastUpdateDate": "03/23/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WILMOTH",
"AuthorizedOfficialFirstName": "JEFFREY",
"AuthorizedOfficialMiddleName": "MARCUS",
"AuthorizedOfficialTitle": "SECRETARY-TREASURER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "415-595-6734",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208D00000X",
"TaxonomyName": "General Practice Physician",
"LicenseNumber": "2657039-0",
"LicenseNumberStateCode": "FL",
"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."
}
}
}
}