{
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"NamePrefix": null,
"NameSuffix": null,
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"FirstLineMailingAddress": "415 S 28TH AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HATTIESBURG",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "39401-7246",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "601-579-5463",
"MailingAddressFaxNumber": "601-579-5240",
"FirstLinePracticeLocationAddress": "101 COURTENAY CIR",
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"PracticeLocationAddressCityName": "HATTIESBURG",
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"PracticeLocationAddressPostalCode": "39402-3153",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "601-579-5180",
"PracticeLocationAddressFaxNumber": "601-268-5851",
"EnumerationDate": "12/14/2006",
"LastUpdateDate": "02/22/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BATSON",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "601-264-6000",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QS1200X",
"TaxonomyName": "Sleep Disorder Diagnostic Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}