{
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"FirstLineMailingAddress": "2140 PEACHTREE RD NW STE 223",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ATLANTA",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30309-1316",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "770-520-8505",
"MailingAddressFaxNumber": "770-520-8502",
"FirstLinePracticeLocationAddress": "2140 PEACHTREE RD NW STE 223",
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"PracticeLocationAddressCityName": "ATLANTA",
"PracticeLocationAddressStateName": "GA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "770-520-8505",
"PracticeLocationAddressFaxNumber": "770-520-8502",
"EnumerationDate": "02/09/2017",
"LastUpdateDate": "03/25/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GOH",
"AuthorizedOfficialFirstName": "ADELINE",
"AuthorizedOfficialMiddleName": "C",
"AuthorizedOfficialTitle": "OWNER/OPTOMETRIST",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OD",
"AuthorizedOfficialTelephoneNumber": "404-720-7721",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "OPT002903",
"LicenseNumberStateCode": "GA",
"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."
}
}
}
}