Individual
DR. BABATUNDE TENITAYO FARIYIKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
612 W GORDON ST STE A, THOMASTON, GA 30286-3480
(706) 647-8065
(706) 647-8019
Mailing address
PO BOX 84, THOMASTON, GA 30286-0002
(706) 647-8065
(706) 647-8019
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
037532
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00572008A
—
GA
05
—
00572008B
—
GA
01
—
582084278
TAX ID
GA
Enumeration date
06/13/2005
Last updated
07/21/2022
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