{
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"FirstLineMailingAddress": "4898 VALLEYDALE RD",
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"FirstLinePracticeLocationAddress": "4898 VALLEYDALE RD",
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"EnumerationDate": "11/21/2013",
"LastUpdateDate": "10/14/2015",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STOUDENMIRE",
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"AuthorizedOfficialCredential": "MS, ALC, ICADC, SAP",
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}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}