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1740611474 NPI number — GILL REYNOLDS-PRIDGETT

NPI Number: 1740611474
Health Care Provider/Practitioner: GILL REYNOLDS-PRIDGETT

Information about “1740611474” NPI (GILL REYNOLDS-PRIDGETT) exists in 1740611474 in HTML format HTML  |  1740611474 in plain Text format TXT  |  1740611474 in PDF (Portable Document Format) PDF  |  1740611474 in an XML format XML  formats.

NPI Number : 1740611474 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1740611474",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "GILL REYNOLDS-PRIDGETT",
    "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": "1320 MAIN ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COLUMBIA",
    "MailingAddressStateName": "SC",
    "MailingAddressPostalCode": "29201-3204",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "866-559-5735",
    "MailingAddressFaxNumber": "866-558-2242",
    "FirstLinePracticeLocationAddress": "12 PERIMETER PARK S",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BIRMINGHAM",
    "PracticeLocationAddressStateName": "AL",
    "PracticeLocationAddressPostalCode": "35243-2326",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "866-559-5735",
    "PracticeLocationAddressFaxNumber": "866-558-2242",
    "EnumerationDate": "12/05/2013",
    "LastUpdateDate": "12/05/2013",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "REYNOLDS-PRIDGETT",
    "AuthorizedOfficialFirstName": "GILL",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "CEO",
    "AuthorizedOfficialTelephoneNumber": "18665595735",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "251V00000X",
          "TaxonomyName": "Voluntary or Charitable Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
      }
    }
  }
}
                
            

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