NPI Code Detail JSON Logo

1609748110 NPI number — DA BIG JUS WAYYY

NPI Number: 1609748110
Health Care Provider/Practitioner: DA BIG JUS WAYYY

Information about “1609748110” NPI (DA BIG JUS WAYYY) exists in 1609748110 in HTML format HTML  |  1609748110 in plain Text format TXT  |  1609748110 in PDF (Portable Document Format) PDF  |  1609748110 in an XML format XML  formats.

NPI Number : 1609748110 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1609748110",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "DA BIG JUS WAYYY",
    "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": "3753 CLANTON RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "AUGUSTA",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30906-9604",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "113 S PERRY ST STE 206",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAWRENCEVILLE",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30046-4811",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "762-383-5323",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/23/2025",
    "LastUpdateDate": "09/23/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "COLLINS",
    "AuthorizedOfficialFirstName": "JUSTINA",
    "AuthorizedOfficialMiddleName": "SHAREE",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "762-383-5323",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "291U00000X",
        "TaxonomyName": "Clinical Medical Laboratory",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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