{
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"FirstLineMailingAddress": "3801 NORTHSDIE DR",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "478-475-4160",
"FirstLinePracticeLocationAddress": "627 S HOUSTON LAKE RD",
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"EnumerationDate": "08/20/2007",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BIRD",
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"Taxonomies": {
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"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}