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1649975947 NPI number — TERRY LEE SMITH

NPI Number: 1649975947
Health Care Provider/Practitioner: TERRY LEE SMITH

Information about “1649975947” NPI (TERRY LEE SMITH) exists in 1649975947 in HTML format HTML  |  1649975947 in plain Text format TXT  |  1649975947 in PDF (Portable Document Format) PDF  |  1649975947 in an XML format XML  formats.

NPI Number : 1649975947 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1649975947",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SMITH",
    "FirstName": "TERRY",
    "MiddleName": "LEE",
    "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": "7108 S KANNER HWY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "STUART",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "34997-7462",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "702 TINSLEY ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DALTON",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30720-7433",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "706-934-1868",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/04/2023",
    "LastUpdateDate": "04/04/2023",
    "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": "106S00000X",
        "TaxonomyName": "Behavior Technician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "GA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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