{
"Npi": {
"NPI": "1790076966",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CRISP REGIONAL HOSPITAL",
"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": "910 N 5TH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CORDELE",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31015-3254",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "229-271-4600",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "910 N 5TH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CORDELE",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "31015-3254",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "229-271-4600",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/22/2011",
"LastUpdateDate": "04/22/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BORELAND",
"AuthorizedOfficialFirstName": "SAMANTHA",
"AuthorizedOfficialMiddleName": "DAHLIA",
"AuthorizedOfficialTitle": "OBSTETRICIAN/GYNECOLOGIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD,MHSA",
"AuthorizedOfficialTelephoneNumber": "229-276-3101",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "282NW0100X",
"TaxonomyName": "Women's Hospital",
"LicenseNumber": "65938",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}