Provider Demographics
NPI:1124095021
Name:IFARINDE, JOAN (MD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:
Last Name:IFARINDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4950
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30023-4950
Mailing Address - Country:US
Mailing Address - Phone:678-736-6000
Mailing Address - Fax:678-736-6004
Practice Address - Street 1:3075 RONALD REAGAN BLVD
Practice Address - Street 2:SUITE 501
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6052
Practice Address - Country:US
Practice Address - Phone:678-736-6000
Practice Address - Fax:678-736-6004
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA062122208000000X, 2080A0000X, 208D00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice