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1659164796 NPI number — JUAN ANTONIO

NPI Number: 1659164796
Health Care Provider/Practitioner: JUAN ANTONIO

Information about “1659164796” NPI (JUAN ANTONIO) exists in 1659164796 in HTML format HTML  |  1659164796 in plain Text format TXT  |  1659164796 in PDF (Portable Document Format) PDF  |  1659164796 in an XML format XML  formats.

NPI Number : 1659164796 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1659164796",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ANTONIO",
    "FirstName": "JUAN",
    "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": "3716 BOLDING CIR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FLOWERY BRANCH",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30542-3054",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "770-561-3206",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1021 CENTRAL AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DEMOREST",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30535-5252",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "706-778-8500",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/22/2025",
    "LastUpdateDate": "05/22/2025",
    "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": "2255A2300X",
        "TaxonomyName": "Athletic Trainer",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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