{
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"EIN": null,
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"OrgName": "ABERCORN FAMILY MEDICAL CENTER",
"LastName": null,
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"FirstLineMailingAddress": "PO BOX 60967",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAVANNAH",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31420-0967",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "912-201-3144",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "8880 ABERCORN ST",
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"PracticeLocationAddressCityName": "SAVANNAH",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "31406-4508",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "912-201-3144",
"PracticeLocationAddressFaxNumber": "912-349-4078",
"EnumerationDate": "08/04/2011",
"LastUpdateDate": "09/15/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BOWLIN",
"AuthorizedOfficialFirstName": "WALLINGFORD",
"AuthorizedOfficialMiddleName": "H",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "912-656-9938",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": null,
"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."
}
}
}
}