{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "PPCP SPECIALTY PHYSICIANS , LLC",
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"FirstLineMailingAddress": "PO BOX 530062",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ATLANTA",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30353-0062",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "843-695-6071",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1101 OLD TROLLEY RD",
"SecondLinePracticeLocationAddress": "STE 300",
"PracticeLocationAddressCityName": "SUMMERVILLE",
"PracticeLocationAddressStateName": "SC",
"PracticeLocationAddressPostalCode": "29485-5293",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "843-376-2670",
"PracticeLocationAddressFaxNumber": "843-376-2790",
"EnumerationDate": "02/22/2017",
"LastUpdateDate": "02/28/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CUNNINGHAM",
"AuthorizedOfficialFirstName": "TERRY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "843-572-7727",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207RE0101X",
"TaxonomyName": "Endocrinology, Diabetes & Metabolism Physician",
"LicenseNumber": "31768",
"LicenseNumberStateCode": "SC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}