{
"Npi": {
"NPI": "1780034454",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "VOLUMINOUS VIRGIN HAIR BOUTIQUE",
"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": "445 EG.MILES PARKWAY",
"SecondLineMailingAddress": "207",
"MailingAddressCityName": "HINESVILLE",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31313-9623",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "912-877-7797",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "445 ELMA G MILES PKWY",
"SecondLinePracticeLocationAddress": "207",
"PracticeLocationAddressCityName": "HINESVILLE",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "31313-3230",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "912-877-7797",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/14/2016",
"LastUpdateDate": "06/14/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DOMINIC",
"AuthorizedOfficialFirstName": "KENYA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MEMBER MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "912-877-7797",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "20725",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}