Healthcare Provider Details

I. General information

NPI: 1689011181
Provider Name (Legal Business Name): TEMITOPE IBEREOLA AFON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5244 MEMORIAL DR STE 1101
STONE MOUNTAIN GA
30083-3157
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 200
MIAMI FL
33126-3168
US

V. Phone/Fax

Practice location:
  • Phone: 404-905-0100
  • Fax: 877-890-2406
Mailing address:
  • Phone: 305-500-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number074031
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: