{
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"OrgName": "CAMP CREEK PRIMARY CARE, PC",
"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "PO BOX 90237",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EAST POINT",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30364-0237",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "404-349-2273",
"MailingAddressFaxNumber": "404-349-1511",
"FirstLinePracticeLocationAddress": "3890 REDWINE RD SW",
"SecondLinePracticeLocationAddress": "SUITE 100",
"PracticeLocationAddressCityName": "ATLANTA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "404-349-2273",
"PracticeLocationAddressFaxNumber": "404-349-1511",
"EnumerationDate": "08/31/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GREEN-CLOPTON",
"AuthorizedOfficialFirstName": "LISA",
"AuthorizedOfficialMiddleName": "B.",
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"AuthorizedOfficialCredential": "JD",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "043019",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}