Healthcare Provider Details

I. General information

NPI: 1780421016
Provider Name (Legal Business Name): AILAF TESFAYE DARFOOR PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

953 MONTREAL RD
CLARKSTON GA
30021-1404
US

IV. Provider business mailing address

953 MONTREAL RD
CLARKSTON GA
30021-1404
US

V. Phone/Fax

Practice location:
  • Phone: 425-648-1998
  • Fax:
Mailing address:
  • Phone: 425-648-1998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN24283
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-NP242831
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: