Provider Demographics
NPI:1265436760
Name:FARIYIKE, BABATUNDE TENITAYO (MD)
Entity type:Individual
Prefix:DR
First Name:BABATUNDE
Middle Name:TENITAYO
Last Name:FARIYIKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037532207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA582084278OtherTAX ID
GA00572008AMedicaid
GA00572008BMedicaid
GA39BDBRLMedicare ID - Type Unspecified
GA00572008AMedicaid