Provider Demographics
NPI:1164200994
Name:AJANI, AJARATU M
Entity Type:Individual
Prefix:
First Name:AJARATU
Middle Name:M
Last Name:AJANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 MEYER FARM RD
Mailing Address - Street 2:
Mailing Address - City:ARNOLDSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30619-1532
Mailing Address - Country:US
Mailing Address - Phone:706-899-0321
Mailing Address - Fax:
Practice Address - Street 1:109 MEYER FARM RD
Practice Address - Street 2:
Practice Address - City:ARNOLDSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30619-1532
Practice Address - Country:US
Practice Address - Phone:706-899-0321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCH009314311ZA0620X
310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home