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"FirstLineMailingAddress": "717 S COLUMBUS BLVD UNIT 512",
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"FirstLinePracticeLocationAddress": "4104 LAVISTA RD STE A",
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"EnumerationDate": "02/22/2022",
"LastUpdateDate": "02/22/2022",
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"NPIReactivationDate": null,
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"AuthorizedOfficialLastName": "SMITH",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}