{
"Npi": {
"NPI": "1881830651",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "J. DON KELLEY DMD PA",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4501 OLD SPARTANBURG RD STE 4",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TAYLORS",
"MailingAddressStateName": "SC",
"MailingAddressPostalCode": "29687-4105",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "864-244-0044",
"MailingAddressFaxNumber": "864-244-1104",
"FirstLinePracticeLocationAddress": "4501 OLD SPARTANBURG RD STE 4",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TAYLORS",
"PracticeLocationAddressStateName": "SC",
"PracticeLocationAddressPostalCode": "29687-4105",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "864-244-0044",
"PracticeLocationAddressFaxNumber": "864-244-1104",
"EnumerationDate": "12/30/2008",
"LastUpdateDate": "12/30/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KELLEY",
"AuthorizedOfficialFirstName": "JEFFREY",
"AuthorizedOfficialMiddleName": "DON",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DMD",
"AuthorizedOfficialTelephoneNumber": "864-244-0044",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "30-01944",
"LicenseNumberStateCode": "SC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}