{
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"FirstLineMailingAddress": "PO BOX 12",
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"MailingAddressStateName": "GA",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "229-616-1165",
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"EnumerationDate": "03/20/2016",
"LastUpdateDate": "11/29/2021",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
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"AuthorizedOfficialLastName": "SWARTZENTRUBER",
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}
},
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}
}
}
}