{
"Npi": {
"NPI": "1811422439",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KWIK KARE OF GEORGIA, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2511 HIGHWAY 34 E",
"SecondLineMailingAddress": "SUITE C",
"MailingAddressCityName": "NEWNAN",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30265-2309",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "770-573-0167",
"MailingAddressFaxNumber": "678-809-2923",
"FirstLinePracticeLocationAddress": "2511 HIGHWAY 34 E",
"SecondLinePracticeLocationAddress": "SUITE C",
"PracticeLocationAddressCityName": "NEWNAN",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30265-2309",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "770-573-0167",
"PracticeLocationAddressFaxNumber": "678-809-2923",
"EnumerationDate": "04/21/2017",
"LastUpdateDate": "04/21/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KOZUSNIK",
"AuthorizedOfficialFirstName": "LORI",
"AuthorizedOfficialMiddleName": "ELAINE",
"AuthorizedOfficialTitle": "OFFICE MANAGER",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "770-573-0167",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QU0200X",
"TaxonomyName": "Urgent Care Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}