{
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"FirstLineMailingAddress": "326 RIDGE TRL",
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"MailingAddressCityName": "RIVERDALE",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30274-1954",
"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "7078 BETHEL CT",
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"EnumerationDate": "10/09/2012",
"LastUpdateDate": "10/09/2012",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CASEY",
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"AuthorizedOfficialTelephoneNumber": "678-451-2890",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Assisted Living Facility",
"LicenseNumber": "031011731",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}