{
"Npi": {
"NPI": "1982733267",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SCOTT AND MARY HARTZOG, 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": "PO BOX 337",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DONALSONVILLE",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "39845-0337",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "229-524-5364",
"MailingAddressFaxNumber": "229-524-8798",
"FirstLinePracticeLocationAddress": "111 E 2ND ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DONALSONVILLE",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "39845-1601",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "229-524-5364",
"PracticeLocationAddressFaxNumber": "229-524-8798",
"EnumerationDate": "03/05/2007",
"LastUpdateDate": "09/24/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HARTZOG",
"AuthorizedOfficialFirstName": "SCOTT",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "229-524-2223",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PHRE009128",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}