Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 062122 | GA |
N | 2080A0000X | Adolescent Medicine | 062122 | GA |
N | 208D00000X | General Practice Physician | 062122 | GA |
NPI | 1124095021 |
---|---|
Provider Name | Dr. Joan Ifarinde |
First Address | Alpharetta, GA 30023-4950 |
Second Address | Cumming, GA 30041-6052 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2006 |
Last Update Date | 02/01/2017 |