{
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"FirstLineMailingAddress": "2230 HARPERFIELD TER",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BOGART",
"MailingAddressStateName": "GA",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "678-936-0273",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3651 MARS HILL ROAD",
"SecondLinePracticeLocationAddress": "SUITE 2900",
"PracticeLocationAddressCityName": "WATKINSVILLE",
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"PracticeLocationAddressFaxNumber": "706-395-8759",
"EnumerationDate": "11/02/2023",
"LastUpdateDate": "04/04/2025",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PRELL",
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"AuthorizedOfficialCredential": "PT",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Physical Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
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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."
}
}
}
}