{
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"FirstLineMailingAddress": "PO BOX 568",
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"MailingAddressStateName": "AL",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "27550 STATE HIGHWAY 75 STE 105",
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"EnumerationDate": "02/25/2013",
"LastUpdateDate": "07/18/2019",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ATA",
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"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "256-599-7566",
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"TaxonomyName": "Multi-Specialty Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": "AL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}