{
"Npi": {
"NPI": "1952587644",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EDGAR H PEACOCK, JR, DDS, PA",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2750 LAUREL ST",
"SecondLineMailingAddress": "SUITE 202",
"MailingAddressCityName": "COLUMBIA",
"MailingAddressStateName": "SC",
"MailingAddressPostalCode": "29204-2038",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "803-256-9268",
"MailingAddressFaxNumber": "803-256-0084",
"FirstLinePracticeLocationAddress": "2750 LAUREL ST",
"SecondLinePracticeLocationAddress": "SUITE 202",
"PracticeLocationAddressCityName": "COLUMBIA",
"PracticeLocationAddressStateName": "SC",
"PracticeLocationAddressPostalCode": "29204-2038",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "803-256-9268",
"PracticeLocationAddressFaxNumber": "803-256-0084",
"EnumerationDate": "01/14/2008",
"LastUpdateDate": "01/14/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PEACOCK",
"AuthorizedOfficialFirstName": "EDGAR",
"AuthorizedOfficialMiddleName": "HAROLD",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "D. D. S",
"AuthorizedOfficialTelephoneNumber": "803-256-9268",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223S0112X",
"TaxonomyName": "Oral and Maxillofacial Surgery (Dentist)",
"LicenseNumber": "1545/OS161",
"LicenseNumberStateCode": "SC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}