Provider Demographics
NPI:1730262163
Name:BABATUNDE FARIYIKE, M.D., LLC
Entity type:Organization
Organization Name:BABATUNDE FARIYIKE, M.D., LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BABATUNDE
Authorized Official - Middle Name:
Authorized Official - Last Name:FARIYIKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-647-8065
Mailing Address - Street 1:PO BOX 84
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-0002
Mailing Address - Country:US
Mailing Address - Phone:706-647-8065
Mailing Address - Fax:706-647-8019
Practice Address - Street 1:612 W GORDON ST STE A
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3480
Practice Address - Country:US
Practice Address - Phone:706-647-8065
Practice Address - Fax:706-647-8019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F67762Medicare UPIN