{
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"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "1150 KIRKLAND LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DOUGLAS",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31533-2044",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "912-384-6630",
"MailingAddressFaxNumber": "912-384-0418",
"FirstLinePracticeLocationAddress": "1150B KIRKLAND LN",
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"PracticeLocationAddressCityName": "DOUGLAS",
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"PracticeLocationAddressTelephoneNumber": "912-384-6630",
"PracticeLocationAddressFaxNumber": "912-384-0418",
"EnumerationDate": "08/18/2020",
"LastUpdateDate": "08/18/2020",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "AMIN",
"AuthorizedOfficialFirstName": "MAHENDRA",
"AuthorizedOfficialMiddleName": "KUMAR GOVINDBHAI",
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"AuthorizedOfficialCredential": "MD, PC",
"AuthorizedOfficialTelephoneNumber": "912-381-2000",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
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}
}