{
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"FirstLineMailingAddress": "PO BOX 63082",
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"MailingAddressStateName": "NC",
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"FirstLinePracticeLocationAddress": "2245 STANTONSBURG RD STE H",
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"EnumerationDate": "02/16/2012",
"LastUpdateDate": "07/17/2023",
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "GRANT",
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"AuthorizedOfficialTelephoneNumber": "336-282-0132",
"Taxonomies": {
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"TaxonomyName": "Pain Medicine (Anesthesiology) Physician",
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"LicenseNumberStateCode": "NC",
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}
},
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}
}
}
}