Provider Demographics
NPI:1396880837
Name:OKAFOR, TAISHA K (MD)
Entity type:Individual
Prefix:DR
First Name:TAISHA
Middle Name:K
Last Name:OKAFOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TAISHA
Other - Middle Name:K
Other - Last Name:WALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:236 ARROWHEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-1106
Mailing Address - Country:US
Mailing Address - Phone:770-478-9240
Mailing Address - Fax:770-478-0318
Practice Address - Street 1:236 ARROWHEAD BLVD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1106
Practice Address - Country:US
Practice Address - Phone:770-478-9240
Practice Address - Fax:770-478-0318
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44743208000000X
GA059937208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA907907838CMedicaid
TN1513136Medicaid