{
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"OrgName": "W. MAX COUCH, JR., DDS, MDS, LLC",
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"FirstLineMailingAddress": "2714 EAST FIRST STREET",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BLUE RIDGE",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30513",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "770-833-9150",
"MailingAddressFaxNumber": "706-946-2672",
"FirstLinePracticeLocationAddress": "2714 EAST FIRST STREET",
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"PracticeLocationAddressCityName": "BLUE RIDGE",
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"PracticeLocationAddressTelephoneNumber": "770-833-9150",
"PracticeLocationAddressFaxNumber": "706-946-2672",
"EnumerationDate": "02/24/2011",
"LastUpdateDate": "02/24/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COUCH",
"AuthorizedOfficialFirstName": "WILLIAM",
"AuthorizedOfficialMiddleName": "MAX",
"AuthorizedOfficialTitle": "PRESIDENT/ ORTHODONTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "DDS, MDS",
"AuthorizedOfficialTelephoneNumber": "770-833-9150",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223X0400X",
"TaxonomyName": "Orthodontics and Dentofacial Orthopedics Dentistry",
"LicenseNumber": "011895",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}