{
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"FirstLineMailingAddress": "3400 EXECUTIVE DR",
"SecondLineMailingAddress": "SUITE 203",
"MailingAddressCityName": "RALEIGH",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27609-7476",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "919-872-0390",
"MailingAddressFaxNumber": "919-872-0391",
"FirstLinePracticeLocationAddress": "3400 EXECUTIVE DR",
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"PracticeLocationAddressFaxNumber": "919-872-0391",
"EnumerationDate": "03/22/2007",
"LastUpdateDate": "01/12/2011",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DONLEYCOTT",
"AuthorizedOfficialFirstName": "BONNIE",
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"AuthorizedOfficialTitle": "OFFICE MANAGER",
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"AuthorizedOfficialTelephoneNumber": "919-872-0390",
"Taxonomies": {
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"TaxonomyName": "Specialist",
"LicenseNumber": "200400893",
"LicenseNumberStateCode": "NC",
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}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}