Organization
PARESH K THANKI, MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PARESH K THANKI M.D. (PRESIDENT)
(912) 490-0078
Entity
Organization
Contact information
Practice address
1707 BOULEVARD SQ STE A, WAYCROSS, GA 31501-8030
(912) 490-0078
(912) 490-0083
Mailing address
3718 VINEBROOKE DR, VALDOSTA, GA 31605-7418
(912) 490-0078
(912) 490-0083
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
BT9306514
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136071824E
—
GA
01
—
202I265217
MEDICARE PTAN
GA
Enumeration date
12/16/2010
Last updated
12/16/2010
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