{
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"FirstLineMailingAddress": "5115 COVINGTON WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MEMPHIS",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "38134-5619",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "901-207-1267",
"MailingAddressFaxNumber": "901-284-0408",
"FirstLinePracticeLocationAddress": "5115 COVINGTON WAY",
"SecondLinePracticeLocationAddress": "SUITE 5",
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"EnumerationDate": "10/30/2019",
"LastUpdateDate": "10/30/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "EDWARDS",
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"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CO-OWNER",
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"AuthorizedOfficialCredential": "BCBA, LBA",
"AuthorizedOfficialTelephoneNumber": "901-207-1267",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Behavior Analyst",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}