{
"Npi": {
"NPI": "1659539351",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MEDICAL ARTS DENTAL GROUP P.A.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1151 N STATE ST",
"SecondLineMailingAddress": "SUITE 401",
"MailingAddressCityName": "JACKSON",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "39202-2407",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "601-948-2073",
"MailingAddressFaxNumber": "601-354-8773",
"FirstLinePracticeLocationAddress": "1151 N STATE ST",
"SecondLinePracticeLocationAddress": "SUITE 401",
"PracticeLocationAddressCityName": "JACKSON",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "39202-2407",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "601-948-2073",
"PracticeLocationAddressFaxNumber": "601-354-8773",
"EnumerationDate": "05/29/2008",
"LastUpdateDate": "05/29/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NEELY",
"AuthorizedOfficialFirstName": "ROBERT",
"AuthorizedOfficialMiddleName": "JERRY",
"AuthorizedOfficialTitle": "OWNER/ DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.M.D.",
"AuthorizedOfficialTelephoneNumber": "601-948-2073",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "228886",
"LicenseNumberStateCode": "MS",
"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."
}
}
}
}