{
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"EIN": null,
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"IsOrgSubpart": "Y",
"ParentOrgLBN": "CRAWFORD HEALTH CLINIC",
"ParentOrgTIN": null,
"OrgName": "CRAWFORD MOBILE HEALTH CLINIC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 95",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CRAWFORD",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "39743-0095",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "662-435-7800",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "15865 HIGHWAY 14 WEST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MACON",
"PracticeLocationAddressStateName": "MS",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "662-435-7800",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/22/2012",
"LastUpdateDate": "03/22/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "EDWARDS",
"AuthorizedOfficialFirstName": "FELICIA",
"AuthorizedOfficialMiddleName": "DELORIS",
"AuthorizedOfficialTitle": "MANAING PARTNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "NP",
"AuthorizedOfficialTelephoneNumber": "662-435-7800",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
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"LicenseNumberStateCode": "MS",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QR1300X",
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}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}