{
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"FirstLineMailingAddress": "1740 FARNINGHAM LN",
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"MailingAddressCityName": "BURLINGTON",
"MailingAddressStateName": "NC",
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"FirstLinePracticeLocationAddress": "625 PINEY FOREST RD",
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"PracticeLocationAddressStateName": "VA",
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"EnumerationDate": "06/25/2009",
"LastUpdateDate": "06/25/2009",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "CRAWFORD",
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"AuthorizedOfficialTelephoneNumber": "252-414-1460",
"Taxonomies": {
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"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}