{
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"FirstLineMailingAddress": "1813 CEDAR GROVE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CONLEY",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30288-1301",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "404-468-6744",
"MailingAddressFaxNumber": "800-401-2230",
"FirstLinePracticeLocationAddress": "181 W VALLEY AVE STE 209",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BIRMINGHAM",
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"PracticeLocationAddressTelephoneNumber": "205-536-6009",
"PracticeLocationAddressFaxNumber": "800-976-5001",
"EnumerationDate": "07/30/2012",
"LastUpdateDate": "01/07/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BIVINS",
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"AuthorizedOfficialCredential": "CFST",
"AuthorizedOfficialTelephoneNumber": "470-558-5038",
"Taxonomies": {
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"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": null,
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}