{
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"IsOrgSubpart": "N",
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5004 BURKE AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COLUMBIA",
"MailingAddressStateName": "SC",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "803-786-2318",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5004 BURKE AVE",
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"PracticeLocationAddressCityName": "COLUMBIA",
"PracticeLocationAddressStateName": "SC",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/12/2011",
"LastUpdateDate": "12/12/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WATSON",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "803-256-2108",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}