{
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"FirstLineMailingAddress": "755 COMMERCE DR",
"SecondLineMailingAddress": "SUITE 520",
"MailingAddressCityName": "DECATUR",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30030-2627",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "404-373-7818",
"MailingAddressFaxNumber": "404-638-5115",
"FirstLinePracticeLocationAddress": "755 COMMERCE DR",
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"PracticeLocationAddressCityName": "DECATUR",
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"EnumerationDate": "12/10/2013",
"LastUpdateDate": "12/10/2013",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "O'SHEA",
"AuthorizedOfficialFirstName": "MATTHEW",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "404-373-7818",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Dentist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}