{
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"FirstLineMailingAddress": "151 MILAM DR",
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"MailingAddressCityName": "ELLENWOOD",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30294-2975",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "404-452-4101",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2945 BUFORD HWY NE",
"SecondLinePracticeLocationAddress": "SUITE P",
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"PracticeLocationAddressCountryCode": "US",
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"PracticeLocationAddressFaxNumber": "770-922-9501",
"EnumerationDate": "03/29/2009",
"LastUpdateDate": "03/29/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FLEMING",
"AuthorizedOfficialFirstName": "LEVETTE",
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"AuthorizedOfficialTitle": "PHARMACY DIRECTOR",
"AuthorizedOfficialNamePrefix": "MRS.",
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"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "404-452-4101",
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{
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{
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},
{
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},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}