{
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"OrgName": "COMMONWEALTH FOOT & ANKLE SPECIALISTS LLC",
"LastName": null,
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"FirstLineMailingAddress": "4704 BARREL POINT RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PRINCE GEORGE",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "23875-2976",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "305-206-7638",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2552 ALDRIDGE AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SOUTH CHESTERFIELD",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "23834-5306",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "804-365-5898",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/24/2018",
"LastUpdateDate": "07/24/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PHILLINGANE",
"AuthorizedOfficialFirstName": "JUSTIN",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "FOOT & ANKLE SPECIALIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPM",
"AuthorizedOfficialTelephoneNumber": "804-365-5898",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213E00000X",
"TaxonomyName": "Podiatrist",
"LicenseNumber": "0103301225",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"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."
}
}
}
}