{
"Npi": {
"NPI": "1629733373",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CRIMSON THERAPY SERVICES LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1601 HIGHWAY 34 E STE A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NEWNAN",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30265-1325",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "706-250-2281",
"MailingAddressFaxNumber": "678-877-8066",
"FirstLinePracticeLocationAddress": "1601 HIGHWAY 34 E STE A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NEWNAN",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30265-1325",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "706-250-2281",
"PracticeLocationAddressFaxNumber": "678-877-8066",
"EnumerationDate": "11/07/2021",
"LastUpdateDate": "11/18/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "THOMAS",
"AuthorizedOfficialFirstName": "ISIS",
"AuthorizedOfficialMiddleName": "FRANCHESCA",
"AuthorizedOfficialTitle": "SPEECH LANGUAGE PATHOLOGIST",
"AuthorizedOfficialNamePrefix": "MISS",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CCC-SLP",
"AuthorizedOfficialTelephoneNumber": "706-250-2281",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "235Z00000X",
"TaxonomyName": "Speech-Language Pathologist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
}
}
}