{
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"FirstLineMailingAddress": "1136 SAM NEWELL RD STE D",
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"MailingAddressCityName": "MATTHEWS",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28105-5064",
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"MailingAddressTelephoneNumber": "704-560-4388",
"MailingAddressFaxNumber": "704-973-0161",
"FirstLinePracticeLocationAddress": "1136 SAM NEWELL RD STE D",
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"PracticeLocationAddressCityName": "MATTHEWS",
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"EnumerationDate": "08/29/2019",
"LastUpdateDate": "08/29/2019",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MAITLAND",
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"Taxonomies": {
"Taxonomy": {
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}