{
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"OrgName": "PAIN AND SPINE INSTITUTE, LLC",
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"NamePrefix": null,
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"FirstLineMailingAddress": "3400 MCCLURE BRIDGE ROAD",
"SecondLineMailingAddress": "BUILDING A, SUITE B",
"MailingAddressCityName": "DULUTH",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30096",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "678-404-1140",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3400 MCCLURE BRIDGE ROAD",
"SecondLinePracticeLocationAddress": "BUILDING A, SUITE B",
"PracticeLocationAddressCityName": "DULUTH",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/20/2018",
"LastUpdateDate": "02/23/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KWOK",
"AuthorizedOfficialFirstName": "GARRICK",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "678-404-1140",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Pain Clinic/Center",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}