Organization
MINAXI, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HETAL THAKORE MD (OWNER)
(706) 267-7681
Entity
Organization
Contact information
Practice address
3524 LOST TREE CT, MARTINEZ, GA 30907-9500
(706) 267-7681
Mailing address
3524 LOST TREE CT, MARTINEZ, GA 30907-9500
(706) 267-7681
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
GA
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1821184540
INDIVIDUAL NPI
GA
Enumeration date
02/29/2016
Last updated
02/29/2016
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