{
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"FirstLineMailingAddress": "1190 N STATE ST STE 502",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "601-353-0439",
"FirstLinePracticeLocationAddress": "1190 N STATE ST",
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"PracticeLocationAddressFaxNumber": "601-353-0439",
"EnumerationDate": "03/21/2007",
"LastUpdateDate": "09/22/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NICOLS",
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"AuthorizedOfficialCredential": "M.D.",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Surgery Physician",
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
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}
}
}
}