Provider Demographics
NPI:1154849867
Name:WASIM, FATIMA (PHD)
Entity type:Individual
Prefix:DR
First Name:FATIMA
Middle Name:
Last Name:WASIM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4470 MOSSBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-4475
Mailing Address - Country:US
Mailing Address - Phone:678-313-2772
Mailing Address - Fax:
Practice Address - Street 1:1071 CAMBRIDGE SQ STE B
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-1843
Practice Address - Country:US
Practice Address - Phone:678-235-5054
Practice Address - Fax:678-810-0666
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-01
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4956103TH0100X
GAPSY004097103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service