{
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"FirstLineMailingAddress": "343 HANCOCK ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GALLATIN",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "37066-3690",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "615-452-2020",
"MailingAddressFaxNumber": "615-452-2112",
"FirstLinePracticeLocationAddress": "343 HANCOCK ST",
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"PracticeLocationAddressCityName": "GALLATIN",
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"PracticeLocationAddressTelephoneNumber": "615-452-2020",
"PracticeLocationAddressFaxNumber": "615-452-2112",
"EnumerationDate": "11/15/2013",
"LastUpdateDate": "06/23/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KELLOGG",
"AuthorizedOfficialFirstName": "BROOKE",
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"AuthorizedOfficialTitle": "BILLING",
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"AuthorizedOfficialTelephoneNumber": "615-452-2020",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Optometrist",
"LicenseNumber": "1232",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X 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."
}
}
}
}