{
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"EIN": null,
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"FirstLineMailingAddress": "48 ASHLEY AVE",
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"MailingAddressCityName": "CORBIN",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "40701-2830",
"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "606-258-0447",
"FirstLinePracticeLocationAddress": "200 W GORDON ST",
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"PracticeLocationAddressCityName": "CORBIN",
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"PracticeLocationAddressTelephoneNumber": "606-528-9305",
"PracticeLocationAddressFaxNumber": "606-528-9306",
"EnumerationDate": "02/23/2007",
"LastUpdateDate": "07/08/2007",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
"Taxonomy": {
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"LicenseNumber": "006278",
"LicenseNumberStateCode": "KY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}