{
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"FirstLineMailingAddress": "6584 PROFESSIONAL PL",
"SecondLineMailingAddress": "SUITE A",
"MailingAddressCityName": "RIVERDALE",
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"MailingAddressPostalCode": "30274-4942",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "770-477-1115",
"MailingAddressFaxNumber": "770-477-1119",
"FirstLinePracticeLocationAddress": "6584 PROFESSIONAL PL",
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"PracticeLocationAddressTelephoneNumber": "770-477-1115",
"PracticeLocationAddressFaxNumber": "770-477-1119",
"EnumerationDate": "12/17/2009",
"LastUpdateDate": "05/04/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BAKARI",
"AuthorizedOfficialFirstName": "DASHAWN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "770-477-1115",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Specialist",
"LicenseNumber": "0620697",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}