{
"Npi": {
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"FirstLineMailingAddress": "1975 HIGHWAY 54 W STE 205",
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"MailingAddressCityName": "PEACHTREE CITY",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30269-4794",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "4385 JOHNS CREEK PKWY STE 200",
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"PracticeLocationAddressCityName": "SUWANEE",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "770-349-9861",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/09/2006",
"LastUpdateDate": "03/21/2023",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "213ES0103X",
"TaxonomyName": "Foot & Ankle Surgery Podiatrist",
"LicenseNumber": "N004044-1",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "213ES0103X",
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}