{
"Npi": {
"NPI": "1598267239",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "AJOSE-ADEOGUN",
"FirstName": "FOLARERA",
"MiddleName": "OLANIKE",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DDS",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "6244 LAKEVIEW CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "REX",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30273-5032",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "404-213-1200",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5005 RIVERSIDE DR UNIT A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MACON",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "31210-1121",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "478-284-0161",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/07/2018",
"LastUpdateDate": "01/03/2019",
"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": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "DN015575",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}