{
"Npi": {
"NPI": "1568907467",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MARIN GUILLENT",
"FirstName": "LUIS",
"MiddleName": "RAFAEL",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "PA",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "15689 US HIGHWAY 19 N",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "THOMASVILLE",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31792-2622",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "229-225-3912",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "15689 US HIGHWAY 19 N",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "THOMASVILLE",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "31792-2622",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "229-225-3912",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/30/2016",
"LastUpdateDate": "12/31/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "2887",
"LicenseNumberStateCode": "PR",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "246ZC0007X",
"TaxonomyName": "Surgical Assistant",
"LicenseNumber": "16-596",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}