{
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"FirstLineMailingAddress": "PO BOX 405",
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"EnumerationDate": "07/22/2006",
"LastUpdateDate": "06/10/2019",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BANKS",
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"AuthorizedOfficialTelephoneNumber": "810-569-5368",
"Taxonomies": {
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{
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},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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},
{
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}
]
}
}
}