{
"Npi": {
"NPI": "1679063820",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "R. BRIAN HOLLINGSWORTH, DMD, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 307",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WINFIELD",
"MailingAddressStateName": "AL",
"MailingAddressPostalCode": "35594-0307",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "205-512-0343",
"MailingAddressFaxNumber": "205-512-0364",
"FirstLinePracticeLocationAddress": "170 APACHE ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WINFIELD",
"PracticeLocationAddressStateName": "AL",
"PracticeLocationAddressPostalCode": "35594-5400",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "205-512-0343",
"PracticeLocationAddressFaxNumber": "205-512-0364",
"EnumerationDate": "05/14/2018",
"LastUpdateDate": "05/14/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HOLLINGSWORTH",
"AuthorizedOfficialFirstName": "ROBERT",
"AuthorizedOfficialMiddleName": "BRIAN",
"AuthorizedOfficialTitle": "DENTIST / OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DMD",
"AuthorizedOfficialTelephoneNumber": "205-512-0343",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "5164",
"LicenseNumberStateCode": "AL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}