{
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"FirstLineMailingAddress": "PO BOX 304",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "731-614-4614",
"FirstLinePracticeLocationAddress": "120 E MAIN ST",
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"PracticeLocationAddressCityName": "ADAMSVILLE",
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"PracticeLocationAddressFaxNumber": "731-614-4614",
"EnumerationDate": "04/27/2026",
"LastUpdateDate": "05/01/2026",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COTHAM",
"AuthorizedOfficialFirstName": "ROBERTA",
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"AuthorizedOfficialCredential": "DSW,MSW,MHP",
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"Taxonomies": {
"Taxonomy": {
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}