{
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"FirstName": null,
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"FirstLineMailingAddress": "PO BOX 552",
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"MailingAddressCityName": "MONETA",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "24121-0552",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "540-206-4039",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3456 FELDSPAR RD",
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"PracticeLocationAddressCityName": "MONETA",
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"PracticeLocationAddressTelephoneNumber": "540-204-0454",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/02/2020",
"LastUpdateDate": "01/02/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DREW",
"AuthorizedOfficialFirstName": "DWAYNE",
"AuthorizedOfficialMiddleName": "DELANO",
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"AuthorizedOfficialCredential": "M.M.F.T., B.T.H.,",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "347E00000X",
"TaxonomyName": "Transportation Broker",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}