{
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"FirstLineMailingAddress": "4704 WHITESBURG DR SW STE 201",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HUNTSVILLE",
"MailingAddressStateName": "AL",
"MailingAddressPostalCode": "35802-1681",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "256-489-5215",
"MailingAddressFaxNumber": "256-489-5700",
"FirstLinePracticeLocationAddress": "4704 WHITESBURG DR SW STE 201",
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"PracticeLocationAddressCityName": "HUNTSVILLE",
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"PracticeLocationAddressTelephoneNumber": "256-489-5215",
"PracticeLocationAddressFaxNumber": "256-489-5700",
"EnumerationDate": "09/15/2006",
"LastUpdateDate": "01/24/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COST",
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"AuthorizedOfficialMiddleName": "A",
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"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "MD",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207QS0010X",
"TaxonomyName": "Sports Medicine (Family Medicine) Physician",
"LicenseNumber": "94133",
"LicenseNumberStateCode": "AL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}