{
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"IsOrgSubpart": "Y",
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"FirstLineMailingAddress": "16850 STATE HIGHWAY 58 S STE A",
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"MailingAddressCityName": "DECATUR",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "423-507-7961",
"MailingAddressFaxNumber": "423-454-0125",
"FirstLinePracticeLocationAddress": "16850 STATE HIGHWAY 58 SOUTH",
"SecondLinePracticeLocationAddress": "SUITE A",
"PracticeLocationAddressCityName": "DECATUR",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "423-506-3781",
"PracticeLocationAddressFaxNumber": "423-454-0125",
"EnumerationDate": "03/23/2023",
"LastUpdateDate": "02/06/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ROBERTS",
"AuthorizedOfficialFirstName": "ENGLISH",
"AuthorizedOfficialMiddleName": "PAIGE",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "FNP",
"AuthorizedOfficialTelephoneNumber": "423-334-2300",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QP2300X",
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP2300X",
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}