{
"Npi": {
"NPI": "1952412413",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SOUTH GEORGIA SURGERY CENTER, 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": "306 ISABELLA STREET",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WAYCROSS",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31501-3636",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "912-267-9000",
"MailingAddressFaxNumber": "912-267-9028",
"FirstLinePracticeLocationAddress": "306 ISABELLA STREET",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WAYCROSS",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "31501-3636",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "912-490-7246",
"PracticeLocationAddressFaxNumber": "912-490-7247",
"EnumerationDate": "08/31/2006",
"LastUpdateDate": "04/08/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LUPI",
"AuthorizedOfficialFirstName": "MICHAEL",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DO",
"AuthorizedOfficialTelephoneNumber": "912-267-9000",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": "111252ASCA",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}