{
"Npi": {
"NPI": "1801520564",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "DEYOUNG",
"FirstName": "MARYN",
"MiddleName": "HAYWARD",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PA-C, MPH",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "HAYWARD",
"OtherFirstName": "MARYN",
"OtherMiddleName": "BURNS",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "PA-C, MPH",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "5582 MEMORIAL DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "STONE MOUNTAIN",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30083-3215",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "404-492-7346",
"MailingAddressFaxNumber": "404-297-7595",
"FirstLinePracticeLocationAddress": "5582 MEMORIAL DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "STONE MOUNTAIN",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30083-3215",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "44-927-3464",
"PracticeLocationAddressFaxNumber": "404-297-7595",
"EnumerationDate": "07/10/2022",
"LastUpdateDate": "04/27/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "11451",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}