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General NPI Number Information
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NPI Number | 1740826643
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Entity Type | Individual
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Provider Name | IDARA INOKON AJALA
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Gender | Female
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Dates
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Enumeration Date | 11/26/2019
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 2782 N COBB PKWY
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City | KENNESAW
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State | GA
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Zip | 30152-3472
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Country | US
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Telephone | 866-389-2727
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Fax |
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Provider Business Mailing Address
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Address Line | 2782 N COBB PKWY
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City | KENNESAW
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State | GA
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Zip | 30152-3472
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Country | US
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Telephone | 866-389-2727
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 37662
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 201317
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License Number State | ND
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5021546
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 121412
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License Number State | WV
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AC007091
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License Number State | MD
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Taxonomy #6
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 014096
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License Number State | CT
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Taxonomy #7
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ15319800
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License Number State | NJ
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Taxonomy #8
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F344819-01
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License Number State | NY
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Taxonomy #9
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 29580
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License Number State | SC
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Taxonomy #10
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CP003464
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License Number State | SD
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Taxonomy #11
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024192081
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License Number State | VA
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Taxonomy #12
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP032801
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License Number State | PA
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Taxonomy #13
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 344819
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License Number State | NY
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Taxonomy #14
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1616433
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License Number State | WI
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Taxonomy #15
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | GAA-NP001676
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License Number State | GA
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