Healthcare Provider Details

I. General information

NPI: 1376209726
Provider Name (Legal Business Name): JUSTIN IKENNA IKARA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S 8TH ST
GRIFFIN GA
30224-4213
US

IV. Provider business mailing address

601 S 8TH ST
GRIFFIN GA
30224-4213
US

V. Phone/Fax

Practice location:
  • Phone: 470-956-4532
  • Fax: 770-563-0726
Mailing address:
  • Phone: 470-956-4532
  • Fax: 770-563-0726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberIKAR-I079IE
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: