{
"Npi": {
"NPI": "1568867851",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HOWARD D BOOTH JR DDS",
"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": "250 CHARTER LN",
"SecondLineMailingAddress": "SUITE G2",
"MailingAddressCityName": "MACON",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31210-4594",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "478-471-8103",
"MailingAddressFaxNumber": "478-471-9186",
"FirstLinePracticeLocationAddress": "250 CHARTER LN",
"SecondLinePracticeLocationAddress": "SUITE G2",
"PracticeLocationAddressCityName": "MACON",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "31210-4594",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "478-471-8103",
"PracticeLocationAddressFaxNumber": "478-471-9186",
"EnumerationDate": "10/29/2014",
"LastUpdateDate": "10/29/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BOOTH",
"AuthorizedOfficialFirstName": "HOWARD",
"AuthorizedOfficialMiddleName": "DOUGLAS",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "478-471-8103",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "8838",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}