{
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"FirstLineMailingAddress": "120 CALLAWAY COURT",
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"MailingAddressCityName": "BOWLING GREEN",
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"MailingAddressPostalCode": "42103",
"MailingAddressCountryCode": "US",
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"PracticeLocationAddressCityName": "BOWLING GREEN",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "270-782-0716",
"PracticeLocationAddressFaxNumber": "270-746-9603",
"EnumerationDate": "08/29/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ELLIOTT",
"AuthorizedOfficialFirstName": "RANDY",
"AuthorizedOfficialMiddleName": "H",
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"AuthorizedOfficialCredential": "DMD",
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"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "1223P0221X",
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"PrimaryTaxonomySwitch": "N"
},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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{
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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."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
]
}
}
}