{
"Npi": {
"NPI": "1649543034",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "A. BRENT CHUMBLEY, PSC",
"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": "727 W CUMBERLAND GAP PKWY",
"SecondLineMailingAddress": "SUITE D",
"MailingAddressCityName": "CORBIN",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "40701-5194",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "606-523-2000",
"MailingAddressFaxNumber": "606-523-2823",
"FirstLinePracticeLocationAddress": "727 W CUMBERLAND GAP PKWY",
"SecondLinePracticeLocationAddress": "SUITE D",
"PracticeLocationAddressCityName": "CORBIN",
"PracticeLocationAddressStateName": "KY",
"PracticeLocationAddressPostalCode": "40701-5194",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "606-523-2000",
"PracticeLocationAddressFaxNumber": "606-523-2823",
"EnumerationDate": "02/15/2012",
"LastUpdateDate": "02/15/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHUMBLEY",
"AuthorizedOfficialFirstName": "ALVIN",
"AuthorizedOfficialMiddleName": "BRENT",
"AuthorizedOfficialTitle": "PRESIDENT - OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DMD MSD",
"AuthorizedOfficialTelephoneNumber": "606-523-2000",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223X0400X",
"TaxonomyName": "Orthodontics and Dentofacial Orthopedics Dentistry",
"LicenseNumber": "4318",
"LicenseNumberStateCode": "KY",
"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."
}
}
}
}