{
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"IsOrgSubpart": "N",
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"NamePrefix": null,
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"FirstLineMailingAddress": "420 W CHERRY ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JESUP",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31545-1435",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "912-380-8007",
"MailingAddressFaxNumber": "912-380-8007",
"FirstLinePracticeLocationAddress": "420 W CHERRY ST",
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"PracticeLocationAddressCityName": "JESUP",
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"PracticeLocationAddressTelephoneNumber": "912-380-8007",
"PracticeLocationAddressFaxNumber": "912-380-8007",
"EnumerationDate": "01/23/2019",
"LastUpdateDate": "01/23/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ODUM",
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"AuthorizedOfficialCredential": "OD",
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"Taxonomies": {
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"TaxonomyName": "Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}