{
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"EIN": null,
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"OtherCredential": "LMP, CNMT, CMA",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "PO BOX 311691",
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"MailingAddressCityName": "ATLANTA",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31131-1691",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "120 MILLBROOK VILLAGE DR # B202",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TYRONE",
"PracticeLocationAddressStateName": "GA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "404-992-0812",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/30/2019",
"LastUpdateDate": "05/29/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Massage Therapist",
"LicenseNumber": "MT002361",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}