{
"Npi": {
"NPI": "1649204751",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "JIMENEZ",
"FirstName": "MIGUEL",
"MiddleName": "A",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3280 POINTE PKWY STE 2550",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NORCROSS",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30092-3473",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "877-877-7411",
"MailingAddressFaxNumber": "877-877-7411",
"FirstLinePracticeLocationAddress": "3903 S COBB DR SE",
"SecondLinePracticeLocationAddress": "SUITE 105",
"PracticeLocationAddressCityName": "SMYRNA",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30080-6342",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "678-838-6600",
"PracticeLocationAddressFaxNumber": "770-438-1477",
"EnumerationDate": "07/11/2006",
"LastUpdateDate": "10/31/2018",
"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": "207XS0117X",
"TaxonomyName": "Orthopaedic Surgery of the Spine Physician",
"LicenseNumber": "52966",
"LicenseNumberStateCode": "GA",
"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."
}
}
}
}