{
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"FirstLineMailingAddress": "PO BOX 645",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "912-293-3308",
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"FirstLinePracticeLocationAddress": "1702 MEADOWS LN",
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"PracticeLocationAddressTelephoneNumber": "912-805-2198",
"PracticeLocationAddressFaxNumber": "912-805-2997",
"EnumerationDate": "12/04/2024",
"LastUpdateDate": "12/04/2024",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DERRICK",
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"AuthorizedOfficialCredential": "PA-C",
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"Taxonomies": {
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}