{
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"FirstLineMailingAddress": "PO BOX 1488",
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"MailingAddressCityName": "NATCHEZ",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "601-443-2600",
"MailingAddressFaxNumber": "601-445-0362",
"FirstLinePracticeLocationAddress": "54 SGT PRENTISS DR",
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"PracticeLocationAddressCityName": "NATCHEZ",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "601-442-3690",
"PracticeLocationAddressFaxNumber": "601-442-4928",
"EnumerationDate": "12/20/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WESSELMAN",
"AuthorizedOfficialFirstName": "JEFFREY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "601-443-2600",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Specialist",
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"LicenseNumberStateCode": "MS",
"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."
}
}
}
}