{
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"FirstLineMailingAddress": "4180 OLD MILTON PKWY",
"SecondLineMailingAddress": "SUITE 1-D",
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"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30005-2408",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "4180 OLD MILTON PKWY",
"SecondLinePracticeLocationAddress": "SUITE 1-D",
"PracticeLocationAddressCityName": "ALPHARETTA",
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"EnumerationDate": "05/29/2014",
"LastUpdateDate": "05/29/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "REIMBOLD",
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"AuthorizedOfficialTitle": "OPTOMETRY",
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"AuthorizedOfficialCredential": "OD",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Optometrist",
"LicenseNumber": "GA001567",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}