{
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"FirstLineMailingAddress": "2622 LAKE PARK BND",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ACWORTH",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30101-6886",
"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1750 MARIETTA HWY STE 140",
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"PracticeLocationAddressCityName": "CANTON",
"PracticeLocationAddressStateName": "GA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "770-213-7602",
"PracticeLocationAddressFaxNumber": "770-213-7604",
"EnumerationDate": "04/15/2014",
"LastUpdateDate": "04/15/2014",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GREXA",
"AuthorizedOfficialFirstName": "MITCHELL",
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"AuthorizedOfficialCredential": "DC",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Chiropractor",
"LicenseNumber": "CHIR005316",
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"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."
}
}
}
}