{
"Npi": {
"NPI": "1619030129",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "LAIRD",
"FirstName": "WILLIAM",
"MiddleName": "MARTY",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "D.PH.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3456 MISTY MEADOWS DR NW",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DALTON",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30721-1740",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "706-259-3377",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2525 DESALES AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHATTANOOGA",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "37404-1161",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "423-495-8380",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/18/2006",
"LastUpdateDate": "07/08/2007",
"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": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "10890",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "15223",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}