{
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"FirstLineMailingAddress": "5500 MARYLAND WAY",
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"MailingAddressStateName": "TN",
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"FirstLinePracticeLocationAddress": "211 N JEFFERSON ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ALBANY",
"PracticeLocationAddressStateName": "GA",
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"PracticeLocationAddressTelephoneNumber": "229-302-1290",
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"EnumerationDate": "08/12/2021",
"LastUpdateDate": "08/24/2022",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "LEIZMAN",
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"AuthorizedOfficialTelephoneNumber": "216-479-9063",
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}