{
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"FirstLineMailingAddress": "6363 POPLAR AVE",
"SecondLineMailingAddress": "SUITE 340",
"MailingAddressCityName": "MEMPHIS",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "38119-4831",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "901-259-1962",
"MailingAddressFaxNumber": "901-259-1959",
"FirstLinePracticeLocationAddress": "105 WESTWOOD PL",
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"PracticeLocationAddressCityName": "BRENTWOOD",
"PracticeLocationAddressStateName": "TN",
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"PracticeLocationAddressTelephoneNumber": "615-371-3000",
"PracticeLocationAddressFaxNumber": "615-371-3089",
"EnumerationDate": "02/26/2010",
"LastUpdateDate": "12/03/2013",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ABSTON",
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"AuthorizedOfficialTelephoneNumber": "901-259-1962",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Specialist",
"LicenseNumber": "1457436321",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}