{
"Npi": {
"NPI": "1780823062",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SOUTH MENTAL HEALTH",
"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": "115 MARTIN LUTHER KING JR DR SW STE 277",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ATLANTA",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30303-3553",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "404-730-0230",
"MailingAddressFaxNumber": "404-730-0341",
"FirstLinePracticeLocationAddress": "1636 CONNALLY DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "EAST POINT",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30344-2558",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "404-762-4042",
"PracticeLocationAddressFaxNumber": "404-762-3626",
"EnumerationDate": "02/11/2009",
"LastUpdateDate": "02/12/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LATTIMORE",
"AuthorizedOfficialFirstName": "BARBARA",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHD, LPC",
"AuthorizedOfficialTelephoneNumber": "404-730-0249",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "CSW003394",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}