{
"Npi": {
"NPI": "1922563436",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "UNIVERSITY OF NORTH GEORGIA RESEARCH FOUNDATION",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "159 SUNSET DRIVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DAHLONEGA",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30597-0001",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "706-867-2747",
"MailingAddressFaxNumber": "706-864-1493",
"FirstLinePracticeLocationAddress": "159 SUNSET DRIVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DAHLONEGA",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30597-0001",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "706-867-2747",
"PracticeLocationAddressFaxNumber": "706-864-1493",
"EnumerationDate": "02/08/2019",
"LastUpdateDate": "02/20/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NELSON",
"AuthorizedOfficialFirstName": "TOCARRA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CREDENTIALING SPECIALIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "701-282-0081",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}