{
"Npi": {
"NPI": "1760603005",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "STATE OF TENNESSEE",
"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": "1100 ENGLAND DRIVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COOKEVILLE",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "38501-0924",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "931-646-7551",
"MailingAddressFaxNumber": "931-646-7596",
"FirstLinePracticeLocationAddress": "1100 ENGLAND DRIVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "COOKEVILLE",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "38501-0924",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "931-646-7551",
"PracticeLocationAddressFaxNumber": "931-646-7596",
"EnumerationDate": "05/02/2007",
"LastUpdateDate": "02/22/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STEPHENS",
"AuthorizedOfficialFirstName": "TONYA",
"AuthorizedOfficialMiddleName": "G.",
"AuthorizedOfficialTitle": "REGIONAL PHARMACIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMACIST",
"AuthorizedOfficialTelephoneNumber": "931-646-7551",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0002X",
"TaxonomyName": "Clinic Pharmacy",
"LicenseNumber": "4908839",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}