{
"Npi": {
"NPI": "1780694455",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "J MELVIN DEESE JR, MD PC",
"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": "1111 GLYNCO PKWY STE 100",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BRUNSWICK",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31525-7922",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "912-262-9961",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1111 GLYNCO PKWY STE 100",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BRUNSWICK",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "31525-7922",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "912-262-9961",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/08/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LUCAS",
"AuthorizedOfficialFirstName": "PAUL",
"AuthorizedOfficialMiddleName": "R.",
"AuthorizedOfficialTitle": "FINANCIAL ADMIN",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "912-262-9961",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": "063-160",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}