{
"Npi": {
"NPI": "1770929150",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CIRCLE OF FRIENDS: CELEBRATING LIFE, INC",
"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": "401 WESTPARK CT",
"SecondLineMailingAddress": "SUITE 200",
"MailingAddressCityName": "PEACHTREE CITY",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30269-3572",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "678-850-1064",
"MailingAddressFaxNumber": "678-935-3997",
"FirstLinePracticeLocationAddress": "806 OLD MILL TRL",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BALL GROUND",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30107-5182",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "678-783-0126",
"PracticeLocationAddressFaxNumber": "678-935-3997",
"EnumerationDate": "05/13/2013",
"LastUpdateDate": "05/13/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WILLIAMS",
"AuthorizedOfficialFirstName": "LISA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "678-850-1064",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "155014LEX",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}