{
"Npi": {
"NPI": "1790093102",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WOODYS LONGBRANCH PHARMACY INC",
"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": "WOODY'S LONGBRANCH PHARMACY",
"SecondLineMailingAddress": "P.O. BOX 309",
"MailingAddressCityName": "DAHLONEGA",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30533",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "706-867-9493",
"MailingAddressFaxNumber": "706-867-9495",
"FirstLinePracticeLocationAddress": "130 LONG BRANCH RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DAHLONEGA",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30533-7132",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "706-867-9493",
"PracticeLocationAddressFaxNumber": "706-867-9495",
"EnumerationDate": "09/20/2010",
"LastUpdateDate": "03/01/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WOODY",
"AuthorizedOfficialFirstName": "KEVIN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "678-316-3031",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PHRE009678",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}