{
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"FirstLineMailingAddress": "149 RIVERWALK BLVD",
"SecondLineMailingAddress": "SUITE 11",
"MailingAddressCityName": "RIDGELAND",
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"MailingAddressPostalCode": "29936-8190",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "843-645-6377",
"MailingAddressFaxNumber": "843-645-4133",
"FirstLinePracticeLocationAddress": "149 RIVERWALK BLVD",
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"PracticeLocationAddressCityName": "RIDGELAND",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "843-645-6377",
"PracticeLocationAddressFaxNumber": "843-645-4133",
"EnumerationDate": "02/06/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "THURMON",
"AuthorizedOfficialFirstName": "WILLIAM",
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"AuthorizedOfficialNamePrefix": "MR.",
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"AuthorizedOfficialCredential": "PHARM.D.",
"AuthorizedOfficialTelephoneNumber": "843-645-6377",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1835N0905X",
"TaxonomyName": "Nuclear Pharmacist",
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"LicenseNumberStateCode": "SC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}