{
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"FirstLineMailingAddress": "1412 TROTWOOD AVE STE 39",
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"MailingAddressCityName": "COLUMBIA",
"MailingAddressStateName": "TN",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "931-901-0296",
"MailingAddressFaxNumber": "931-901-0299",
"FirstLinePracticeLocationAddress": "1412 TROTWOOD AVE STE 39",
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"PracticeLocationAddressCityName": "COLUMBIA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "931-505-9169",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/11/2022",
"LastUpdateDate": "03/30/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MALIN",
"AuthorizedOfficialFirstName": "DANIELLE",
"AuthorizedOfficialMiddleName": "LOUISE",
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"AuthorizedOfficialCredential": "DPM",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213ES0103X",
"TaxonomyName": "Foot & Ankle Surgery Podiatrist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}