{
"Npi": {
"NPI": "1942969753",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "QOALA HOME CARE, LLC",
"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": "2725 HAMILTON MILL RD STE 500 #221",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BUFORD",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30519",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "423-432-8403",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2911 HAMILTON MILL RD STE A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BUFORD",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30519-4112",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "678-926-1829",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/09/2021",
"LastUpdateDate": "01/15/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WALKER",
"AuthorizedOfficialFirstName": "NELUM",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "FAMILY NURSE PRACTITIONER",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "APN, FNP-C",
"AuthorizedOfficialTelephoneNumber": "423-432-8403",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}