{
"Npi": {
"NPI": "1205919123",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "HARRIS",
"FirstName": "CHARLIE",
"MiddleName": "L",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "PHD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "LOLLIS",
"OtherFirstName": "CHARLIE",
"OtherMiddleName": "M",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "PHD",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "5877 VILLAGE LOOP",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FAIRBURN",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30213-4636",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "404-277-0604",
"MailingAddressFaxNumber": "404-277-0604",
"FirstLinePracticeLocationAddress": "120 MILLBROOK VILLAGE DR STE B203",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TYRONE",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30290-3605",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "770-727-6110",
"PracticeLocationAddressFaxNumber": "800-749-1966",
"EnumerationDate": "10/23/2006",
"LastUpdateDate": "01/08/2020",
"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": "103T00000X",
"TaxonomyName": "Psychologist",
"LicenseNumber": "002080",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}