{
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"FirstLineMailingAddress": "11555 MEDLOCK BRIDGE RD STE 190",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JOHNS CREEK",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30097-1541",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "678-984-3151",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "11315 JOHNS CREEK PKWY",
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"PracticeLocationAddressCityName": "JOHNS CREEK",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30097-2645",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "770-709-6922",
"PracticeLocationAddressFaxNumber": "770-709-6910",
"EnumerationDate": "01/14/2014",
"LastUpdateDate": "09/12/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PANDYA",
"AuthorizedOfficialFirstName": "TANYA",
"AuthorizedOfficialMiddleName": "O.",
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "D.O.",
"AuthorizedOfficialTelephoneNumber": "678-984-3151",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "60956",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}