{
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"FirstLineMailingAddress": "1360 CADUCEUS WAY BLDG 400 SUITE 105",
"SecondLineMailingAddress": null,
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"MailingAddressTelephoneNumber": "706-621-5996",
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"FirstLinePracticeLocationAddress": "1360 CADUCEUS WAY BLDG 400 SUITE 105",
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"EnumerationDate": "03/27/2014",
"LastUpdateDate": "10/04/2024",
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialCredential": "PHARMD",
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}
},
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}
}