{
"Npi": {
"NPI": "1750720058",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CAMELLIA HOME HEALTH OF SOUTHEAST TENNESSEE, 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": "135 MAYFAIR RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HATTIESBURG",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "39402-1464",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "601-544-2903",
"MailingAddressFaxNumber": "601-579-6991",
"FirstLinePracticeLocationAddress": "6711 MOUNTAIN VIEW RD",
"SecondLinePracticeLocationAddress": "SUITE 105",
"PracticeLocationAddressCityName": "OOLTEWAH",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "37363-6668",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "423-414-3017",
"PracticeLocationAddressFaxNumber": "423-238-1199",
"EnumerationDate": "06/19/2013",
"LastUpdateDate": "06/19/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PAYNE",
"AuthorizedOfficialFirstName": "WILFORD",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "PRESIDENT / CEO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "III",
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "601-544-2903",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "107",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}