1659778256 NPI number — GREGORY CARLETON COOLIDGE II C.H.W.C., C.F.N.S.

NPI Number: 1659778256
Health Care Provider/Practitioner: GREGORY CARLETON COOLIDGE II C.H.W.C., C.F.N.S.

NPI Number : 1659778256 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1659778256",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "COOLIDGE",
    "FirstName": "GREGORY",
    "MiddleName": "CARLETON",
    "NamePrefix": null,
    "NameSuffix": "II",
    "Credential": "C.H.W.C., C.F.N.S.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "240 LITTLE ROUND TOP",
    "SecondLineMailingAddress": "#315",
    "MailingAddressCityName": "FORT THOMAS",
    "MailingAddressStateName": "KY",
    "MailingAddressPostalCode": "41075-4417",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "859-757-7060",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "240 LITTLE ROUND TOP",
    "SecondLinePracticeLocationAddress": "#315",
    "PracticeLocationAddressCityName": "FORT THOMAS",
    "PracticeLocationAddressStateName": "KY",
    "PracticeLocationAddressPostalCode": "41075-4417",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "859-757-7060",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/25/2014",
    "LastUpdateDate": "11/25/2014",
    "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": "174H00000X",
        "TaxonomyName": "Health Educator",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}