{
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"FirstLineMailingAddress": "PO BOX 1404",
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"MailingAddressCityName": "ALPHARETTA",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30009-1404",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "770-355-2064",
"MailingAddressFaxNumber": "678-615-2224",
"FirstLinePracticeLocationAddress": "2406 TIFT AVE N",
"SecondLinePracticeLocationAddress": "SUITE 202",
"PracticeLocationAddressCityName": "TIFTON",
"PracticeLocationAddressStateName": "GA",
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"PracticeLocationAddressTelephoneNumber": "770-355-2064",
"PracticeLocationAddressFaxNumber": "229-238-3940",
"EnumerationDate": "12/16/2010",
"LastUpdateDate": "12/16/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GOWDY",
"AuthorizedOfficialFirstName": "DAVID",
"AuthorizedOfficialMiddleName": "PHILLIP",
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"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "770-355-2064",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "34601",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"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."
}
}
}
}