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"FirstLineMailingAddress": "520 COLLINS AIKMAN DR",
"SecondLineMailingAddress": "SUITE E205",
"MailingAddressCityName": "CHARLOTTE",
"MailingAddressStateName": "NC",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "704-726-5467",
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"FirstLinePracticeLocationAddress": "520 COLLINS AIKMAN DR",
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"EnumerationDate": "03/27/2013",
"LastUpdateDate": "03/27/2013",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BLANTON",
"AuthorizedOfficialFirstName": "ANDREANA",
"AuthorizedOfficialMiddleName": "RAMSEUR",
"AuthorizedOfficialTitle": "HAIR LOSS SPECIALIST",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "704-726-5467",
"Taxonomies": {
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}