{
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"FirstLineMailingAddress": "309 N ROBERTS AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LUMBERTON",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28358-5383",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "910-739-0272",
"MailingAddressFaxNumber": "910-739-0375",
"FirstLinePracticeLocationAddress": "309 N ROBERTS AVE",
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"PracticeLocationAddressCityName": "LUMBERTON",
"PracticeLocationAddressStateName": "NC",
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"PracticeLocationAddressTelephoneNumber": "910-739-0272",
"PracticeLocationAddressFaxNumber": "910-739-0375",
"EnumerationDate": "02/17/2011",
"LastUpdateDate": "02/17/2011",
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"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LOCKLEAR",
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"AuthorizedOfficialCredential": "PA-C",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Physician Assistant",
"LicenseNumber": "102608",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}