{
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"FirstLineMailingAddress": "1531 TOWNE PARK CT",
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"FirstLinePracticeLocationAddress": "2594 LOGANVILLE HWY STE 102",
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"EnumerationDate": "09/19/2025",
"LastUpdateDate": "09/19/2025",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHIRA",
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"Taxonomies": {
"Taxonomy": {
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}