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1609384767 NPI number — DAVIS LEGACY ENTERPRISES LLC

NPI Number: 1609384767
Health Care Provider/Practitioner: DAVIS LEGACY ENTERPRISES LLC

Information about “1609384767” NPI (DAVIS LEGACY ENTERPRISES LLC) exists in 1609384767 in HTML format HTML  |  1609384767 in plain Text format TXT  |  1609384767 in PDF (Portable Document Format) PDF  |  1609384767 in an XML format XML  formats.

NPI Number : 1609384767 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1609384767",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "DAVIS LEGACY ENTERPRISES LLC",
    "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": "1400 VETERANS MEMORIAL HWY SE",
    "SecondLineMailingAddress": "SUITE 134 # 444",
    "MailingAddressCityName": "MABLETON",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30126",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4895 CHIMNEY HILL CT",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "AUSTELL",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30106-1765",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "678-398-9619",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/11/2018",
    "LastUpdateDate": "04/08/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "DAVIS",
    "AuthorizedOfficialFirstName": "DAVID",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "404-281-8826",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "251E00000X",
        "TaxonomyName": "Home Health Agency",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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