{
"Npi": {
"NPI": "1154849867",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WASIM",
"FirstName": "FATIMA",
"MiddleName": null,
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "PH.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4470 MOSSBROOK CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ALPHARETTA",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30004-4475",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "678-313-2772",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "555 SUN VALLEY DR STE G4",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ROSWELL",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30076-5607",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "678-235-5054",
"PracticeLocationAddressFaxNumber": "678-810-0666",
"EnumerationDate": "09/01/2017",
"LastUpdateDate": "01/26/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "103TH0100X",
"TaxonomyName": "Health Service Psychologist",
"LicenseNumber": "4956",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "103TC1900X",
"TaxonomyName": "Counseling Psychologist",
"LicenseNumber": "PSY004097",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "103T00000X",
"TaxonomyName": "Psychologist",
"LicenseNumber": "PSY004097",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}