{
"Npi": {
"NPI": "1730903113",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "SOUTHERN SPECIALTY CLINIC, LLC",
"ParentOrgTIN": null,
"OrgName": "SOUTHERN SPECIALTY CLINIC, LLC",
"LastName": null,
"FirstName": null,
"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": "122 WOODLANDS GLEN CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BRANDON",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "39047-7107",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "601-985-8296",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "803 LIBERTY RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FLOWOOD",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "39232-9000",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "601-714-1967",
"PracticeLocationAddressFaxNumber": "601-714-1966",
"EnumerationDate": "11/12/2024",
"LastUpdateDate": "11/12/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PENNINGTON",
"AuthorizedOfficialFirstName": "SHARON",
"AuthorizedOfficialMiddleName": "MARIE",
"AuthorizedOfficialTitle": "CHIEF EXECUTIVE OFFICER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "601-985-8296",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}