{
"Npi": {
"NPI": "1861492282",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "X",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BINGHAM",
"FirstName": "JAELYN",
"MiddleName": "L",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "RPH",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4678 THREE SPRINGS CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MARIETTA",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30062-6351",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "770-518-5622",
"MailingAddressFaxNumber": "404-851-8610",
"FirstLinePracticeLocationAddress": "1000 JOHNSON FERRY RD NE",
"SecondLinePracticeLocationAddress": "NORTHSIDE HOSPITAL PHARMACY",
"PracticeLocationAddressCityName": "ATLANTA",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30342-1606",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "404-303-3519",
"PracticeLocationAddressFaxNumber": "404-851-8610",
"EnumerationDate": "07/28/2005",
"LastUpdateDate": "07/08/2007",
"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": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "RPH018691",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}