{
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"FirstLineMailingAddress": "1412 TROTWOOD AVE STE 82",
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"MailingAddressCityName": "COLUMBIA",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "38401-4982",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "931-388-3104",
"MailingAddressFaxNumber": "931-381-1096",
"FirstLinePracticeLocationAddress": "1412 TROTWOOD AVE STE 82",
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"PracticeLocationAddressCityName": "COLUMBIA",
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"PracticeLocationAddressFaxNumber": "931-381-1096",
"EnumerationDate": "07/27/2007",
"LastUpdateDate": "05/04/2023",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BAKER",
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"AuthorizedOfficialTitle": "OFFICE MANAGER",
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"AuthorizedOfficialTelephoneNumber": "931-388-3104",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Specialist",
"LicenseNumber": "MD010397",
"LicenseNumberStateCode": "TN",
"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."
}
}
}
}