{
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"FirstLineMailingAddress": "1106 OGLETHORPE DR NE",
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"MailingAddressCityName": "BROOKHAVEN",
"MailingAddressStateName": "GA",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "404-414-8211",
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"FirstLinePracticeLocationAddress": "20 GLENLAKE PKWY",
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"PracticeLocationAddressCityName": "ATLANTA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "770-677-6227",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/01/2006",
"LastUpdateDate": "01/10/2022",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Surgery Physician",
"LicenseNumber": "058554",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}