{
"Npi": {
"NPI": "1558802207",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MILES CONNECT LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "165 LAKESTONE PKWY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WOODSTOCK",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30188-5427",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "770-517-8122",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1570 HOLCOMB BRIDGE RD",
"SecondLinePracticeLocationAddress": "SUITE 200",
"PracticeLocationAddressCityName": "ROSWELL",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30076-4703",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "770-518-8120",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/14/2017",
"LastUpdateDate": "03/14/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "IYAMU",
"AuthorizedOfficialFirstName": "EMMANUEL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "770-517-8122",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PHRE010349",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}