{
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"FirstLineMailingAddress": "118 ARTHUR J MOORE DR",
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"MailingAddressCityName": "ST SIMONS ISLAND",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31522-2238",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "912-265-0644",
"MailingAddressFaxNumber": "912-265-7383",
"FirstLinePracticeLocationAddress": "1606 GLOUCESTER ST",
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"PracticeLocationAddressCityName": "BRUNSWICK",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "912-265-7382",
"PracticeLocationAddressFaxNumber": "912-265-7383",
"EnumerationDate": "08/14/2006",
"LastUpdateDate": "02/08/2021",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FAULK",
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"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "912-265-7382",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Psychiatry Physician",
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"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."
}
}
}
}