Provider Demographics
NPI:1649209859
Name:FAIRCLOTH BAKEMAN PARTNERSHIP
Entity Type:Organization
Organization Name:FAIRCLOTH BAKEMAN PARTNERSHIP
Other - Org Name:AIKEN/AUGUSTA ORAL & FACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:S
Authorized Official - Last Name:COCKRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-868-9500
Mailing Address - Street 1:1222 GEORGE C WILSON DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-4502
Mailing Address - Country:US
Mailing Address - Phone:706-868-9500
Mailing Address - Fax:706-868-5081
Practice Address - Street 1:1222 GEORGE C WILSON DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-4502
Practice Address - Country:US
Practice Address - Phone:706-868-9500
Practice Address - Fax:706-868-5081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7561OtherMEDICARE GROUP PIN
SCZA9893Medicaid
GAGRP5093OtherMEDICARE GROUP PIN
GAZAG992Medicaid