{
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"FirstLineMailingAddress": "PO BOX 603086",
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"MailingAddressPostalCode": "28260-3086",
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"FirstLinePracticeLocationAddress": "218 OLD MOCKSVILLE RD",
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"PracticeLocationAddressFaxNumber": "704-873-1352",
"EnumerationDate": "06/17/2015",
"LastUpdateDate": "06/17/2015",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "HILL",
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"AuthorizedOfficialCredential": "MBA, FACMPE, PCMH CC",
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"Taxonomy": {
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}