{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "INTOWN FAMILY PRACTICE & SPORTS MEDICINE PC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "285 BOULEVARD AVE NE",
"SecondLineMailingAddress": "SUITE 640",
"MailingAddressCityName": "ATLANTA",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30312-4212",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "404-577-7800",
"MailingAddressFaxNumber": "404-577-7810",
"FirstLinePracticeLocationAddress": "285 BOULEVARD AVE NE",
"SecondLinePracticeLocationAddress": "SUITE 640",
"PracticeLocationAddressCityName": "ATLANTA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "404-577-7800",
"PracticeLocationAddressFaxNumber": "404-577-7810",
"EnumerationDate": "09/09/2010",
"LastUpdateDate": "09/09/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GOLUSINSKI",
"AuthorizedOfficialFirstName": "LAWRENCE",
"AuthorizedOfficialMiddleName": "LEO",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "404-577-7800",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": "20330",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QP2300X",
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"LicenseNumber": "038777",
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"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}