{
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"FirstLineMailingAddress": "565 LAKE FRONT DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LILBURN",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30047-7317",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "404-550-3248",
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"FirstLinePracticeLocationAddress": "362 UPPER RIVERDALE RD SW",
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"PracticeLocationAddressCityName": "RIVERDALE",
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"PracticeLocationAddressFaxNumber": "770-892-5259",
"EnumerationDate": "09/22/2013",
"LastUpdateDate": "11/07/2013",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "CHANDORA",
"AuthorizedOfficialFirstName": "DEEN",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2084A0401X",
"TaxonomyName": "Addiction Medicine (Psychiatry & Neurology) Physician",
"LicenseNumber": "25954",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}