{
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "13775 HIGHWAY 57 STE 7",
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"EnumerationDate": "08/29/2025",
"LastUpdateDate": "08/29/2025",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WALTON",
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"AuthorizedOfficialTelephoneNumber": "901-850-6822",
"Taxonomies": {
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"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}