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Organization
FAIRCLOTH BAKEMAN PARTNERSHIP
Active
Organization
FAIRCLOTH BAKEMAN PARTNERSHIP
Active
Other names
AIKEN/AUGUSTA ORAL & FACIAL SURGERY
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PAMELA S COCKRELL (INSURANCE COORDINATOR)
(706) 868-9500
Entity
Organization
Contact information
Practice address
1222 GEORGE C WILSON DR, AUGUSTA, GA 30909-4502
(706) 868-9500
(706) 868-5081
Mailing address
1222 GEORGE C WILSON DR, AUGUSTA, GA 30909-4502
(706) 868-9500
(706) 868-5081
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7561
MEDICARE GROUP PIN
SC
01
—
GRP5093
MEDICARE GROUP PIN
GA
05
—
ZA9893
—
SC
05
—
ZAG992
—
GA
Enumeration date
07/01/2006
Last updated
09/24/2008
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