{
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"FirstLineMailingAddress": "4030 SMITH ROAD",
"SecondLineMailingAddress": "SUITE 350",
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"FirstLinePracticeLocationAddress": "4030 SMITH ROAD",
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"EnumerationDate": "04/06/2007",
"LastUpdateDate": "11/29/2022",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WETHINGTON",
"AuthorizedOfficialFirstName": "STEPHANIE",
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"AuthorizedOfficialTitle": "PRACTICE ADMINISTATOR",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "513-349-5512",
"Taxonomies": {
"Taxonomy": {
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}