{
"Npi": {
"NPI": "1902200447",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PEDIATRIC CLINIC, PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "189 MEDICAL WAY",
"SecondLineMailingAddress": "SUITE C",
"MailingAddressCityName": "RIVERDALE",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30274-4905",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "770-991-8900",
"MailingAddressFaxNumber": "770-991-8917",
"FirstLinePracticeLocationAddress": "189 MEDICAL WAY",
"SecondLinePracticeLocationAddress": "SUITE C",
"PracticeLocationAddressCityName": "RIVERDALE",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30274-4905",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "770-991-8900",
"PracticeLocationAddressFaxNumber": "770-991-8917",
"EnumerationDate": "10/13/2014",
"LastUpdateDate": "10/13/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "IQBAL",
"AuthorizedOfficialFirstName": "AMJAD",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "770-991-8900",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": "20280",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}