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1619478013 NPI number — CHRISYANA GEDMYR MEDCARE LLC

NPI Number: 1619478013
Health Care Provider/Practitioner: CHRISYANA GEDMYR MEDCARE LLC

Information about “1619478013” NPI (CHRISYANA GEDMYR MEDCARE LLC) exists in 1619478013 in HTML format HTML  |  1619478013 in plain Text format TXT  |  1619478013 in PDF (Portable Document Format) PDF  |  1619478013 in an XML format XML  formats.

NPI Number : 1619478013 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1619478013",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "CHRISYANA GEDMYR MEDCARE 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": "403 PERMIAN WAY STE A",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "VILLA RICA",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30180-3226",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "403 PERMIAN WAY STE A",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "VILLA RICA",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30180-3226",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "770-771-5235",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/22/2018",
    "LastUpdateDate": "12/28/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ETIENNE",
    "AuthorizedOfficialFirstName": "JOSETTE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "FNP-C",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "FNP-C",
    "AuthorizedOfficialTelephoneNumber": "770-771-5235",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LF0000X",
        "TaxonomyName": "Family Nurse Practitioner",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "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."
      }
    }
  }
}
                
            

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