Provider Demographics
NPI:1780421016
Name:DARFOOR, AILAF TESFAYE
Entity type:Individual
Prefix:
First Name:AILAF
Middle Name:TESFAYE
Last Name:DARFOOR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 GARBROOKE DR # DF
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-2858
Mailing Address - Country:US
Mailing Address - Phone:256-694-0341
Mailing Address - Fax:
Practice Address - Street 1:726 GARBROOKE DR # DF
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-2858
Practice Address - Country:US
Practice Address - Phone:256-694-0341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GANCO-000003363LP0808X
GARN24283163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health